新生儿重症监护室环境布局对极/超早产儿临床结局及神经发育的影响

魏璐; 何莎莎; 张先红

doi:10.7499/j.issn.1008-8830.2302060

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中国当代儿科杂志 ›› 2023, Vol. 25 ›› Issue (8) : 812-817. DOI: 10.7499/j.issn.1008-8830.2302060

论著·临床研究

新生儿重症监护室环境布局对极/超早产儿临床结局及神经发育的影响

魏璐, 何莎莎, 张先红

作者信息 +

Impact of the environmental layout of the neonatal intensive care unit on clinical outcomes and neurological development in very/extremely preterm infants

WEI Lu, HE Sha-Sha, ZHANG Xian-Hong

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摘要

目的探讨新生儿重症监护室（neonatal intensive care unit，NICU）环境布局对极/超早产儿临床结局及神经发育的影响。方法选取重庆医科大学附属儿童医院2021年1月—2022年6月收治、生后24 h内入院的304例极/超早产儿为研究对象。采用回顾性队列研究方法，根据NICU不同环境布局将患儿分为两组，即集中式布局组（157例）和分散式布局组（147例），比较两组患儿临床结局和校正胎龄34~51⁺⁶周时婴儿运动表现测试评分结果。结果分散式布局组支气管肺发育不良（44.9% vs 62.4%）和颅内出血（17.7% vs 28.0%）的发生率低于集中式布局组（均P<0.05）；分散式布局组治愈率高于集中式布局组（68.7% vs 56.7%，P<0.05）。在校正胎龄34~51⁺⁶周时，分散式布局组婴儿运动表现测试评分高于集中式布局组（P<0.05）。结论 NICU分散式环境布局较集中式布局在极/超早产儿临床结局及早期神经发育方面显示出积极的影响。

Abstract

Objective To investigate the impact of the environmental layout of the neonatal intensive care unit (NICU) on clinical outcomes and neurological development in very/extremely preterm infants. Methods A total of 304 very/extremely preterm infants admitted to Children's Hospital of Chongqing Medical University between January 2021 and June 2022 within 24 hours after birth were included in this retrospective cohort study. Based on different environmental layouts in the NICU, the infants were divided into two groups: centralized layout group (n=157) and decentralized layout group (n=147). The clinical outcomes and Test of Infant Motor Performance (TIMP) scores at corrected gestational age between 34 to 51⁺⁶ weeks were compared between the two groups. Results The decentralized layout group had lower incidence rates of bronchopulmonary dysplasia (44.9% vs 62.4%, P<0.05) and intracranial hemorrhage (17.7% vs 28.0%, P<0.05) than the centralized layout group. The cure rate was higher in the decentralized layout group compared to the centralized layout group (68.7% vs 56.7%, P<0.05). The decentralized layout group had higher TIMP scores than the centralized layout group at corrected gestational age between 34 to 51⁺⁶ weeks (P<0.05). Conclusions The decentralized layout of the NICU exhibits positive effects on the clinical outcomes and early neurological development compared to the centralized layout in very/extremely preterm infants.

导出引用

魏璐, 何莎莎, 张先红. 新生儿重症监护室环境布局对极/超早产儿临床结局及神经发育的影响[J]. 中国当代儿科杂志. 2023, 25(8): 812-817 https://doi.org/10.7499/j.issn.1008-8830.2302060

WEI Lu, HE Sha-Sha, ZHANG Xian-Hong. Impact of the environmental layout of the neonatal intensive care unit on clinical outcomes and neurological development in very/extremely preterm infants[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(8): 812-817 https://doi.org/10.7499/j.issn.1008-8830.2302060

参考文献

1 World Health Organization. Preterm birth[EB/OL]. [2022-05-11]. https://www.who.int/news-room/fact-sheets/detail/preterm-birth.
2 朱燕. 出生早产儿流行病学特征的前瞻性多中心调查[D]. 上海: 复旦大学, 2012.
3 陈梅, 周伟, 陈燕霞, 等. 早期外环境良性刺激干预对NICU早产儿生命体征、疼痛、体质量及睡眠的影响[J]. 临床护理杂志, 2022, 21(1): 40-43. DOI: 10.3969/j.issn.1671-8933.2022.01.014.
4 岳少婷, 张军, 马登慧. 新生儿重症监护室环境压力对早产儿神经发育的影响及其表观遗传学研究进展[J]. 中国当代儿科杂志, 2019, 21(11): 1144-1147. PMID: 31753099. PMCID: PMC7389294. DOI: 10.7499/j.issn.1008-8830.2019.11.016.
5 Disher T, Dol J, Richardson B, et al. Single room versus open-bay design in neonatal intensive care units for improvement in infant outcomes: a systematic review protocol[J]. JBI Database System Rev Implement Rep, 2017, 15(10): 2480-2486. PMID: 29035959. DOI: 10.11124/JBISRIR-2017-003346.
6 杨阳. 现代综合医院新生儿重症监护中心（NICU）建筑设计研究[D]. 西安: 西安建筑科技大学, 2017.
7 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 855-860, 632-640, 1025-1029.
8 李芳, 刘立婷. 支气管肺发育不良诊断及治疗中几个关注问题[J]. 临床儿科杂志, 2022, 40(6): 413-419. DOI: 10.12372/jcp.2022.22e0333.
9 宋文亚, 倪育, 罗翠仪, 等. 全身运动评估与婴儿运动表现测试的相关性研究[J]. 中国妇幼健康研究, 2022, 33(2): 1-4. DOI: 10.3969/j.issn.1673-5293.2022.02.001.
10 李永富, 王旭莉, 陈宇宏. 不同新生儿重症监护病房环境对极低出生体重早产儿的影响[J]. 临床与病理杂志, 2020, 40(12): 3228-3234. DOI: 10.3978/j.issn.2095-6959.2020.12.022.
11 van Veenendaal NR, van der Schoor SRD, Limpens J, et al. Effect of single family rooms for preterm infants on neurodevelopment: study protocol for a systematic review[J]. BMJ Open, 2017, 7(8): e015818. PMID: 28780548. PMCID: PMC5629655. DOI: 10.1136/bmjopen-2017-015818.
12 朱柔霖. 病房环境中声光因素对新生儿的影响及控制措施[J]. 中国妇幼保健, 2021, 36(21): 4967-4969. DOI: 10.19829/j.zgfybj.issn.1001-4411.2021.21.026.
13 闫振霞. 基于家庭中心的护理模式对早产儿生长发育的影响[J]. 河南医学研究, 2019, 28(15): 2832-2833. DOI: 10.3969/j.issn.1004-437X.2019.15.073.
14 Tandberg BS, Fr?slie KF, Flacking R, et al. Parent-infant closeness, parents' participation, and nursing support in single-family room and open bay NICUs[J]. J Perinat Neonatal Nurs, 2018, 32(4): E22-E32. PMID: 30358674. DOI: 10.1097/JPN.0000000000000359.
15 中国医师协会新生儿科医师分会. 中国新生儿病房分级建设与管理指南（建议案）[J]. 发育医学电子杂志, 2015, 3(4): 193-202.
16 林楠, 诸纪华, 金陈娣, 等. 新生儿重症监护室发育支持环境管理的推荐意见总结[J]. 中华实用儿科临床杂志, 2022, 37(17): 1325-1330. DOI: 10.3760/cma.j.cn101070-20220120-00076.
17 单若冰, 郭莉. 不同新生儿重症监护室环境对早产儿生理指标和应激激素的影响[J]. 中华围产医学杂志, 2005, 8(3): 206-207. DOI: 10.3760/cma.j.issn.1007-9408.2005.03.021.
18 Brew N, Walker D, Wong FY. Cerebral vascular regulation and brain injury in preterm infants[J]. Am J Physiol Regul Integr Comp Physiol, 2014, 306(11): R773-R786. PMID: 24647591. DOI: 10.1152/ajpregu.00487.2013.
19 黄晓波, 韦琴, 李艳青, 等. 新生儿重症监护病房早产儿睡眠保护策略护理研究进展[J]. 护理管理杂志, 2018, 18(7): 498-502. DOI: 10.3969/j.issn.1671-315x.2018.07.010.
20 郁春, 吴明赴, 符明凤, 等. 早产儿颅内出血的高危因素及临床结局[J]. 贵州医科大学学报, 2019, 44(12): 1486-1490. DOI: 10.19367/j.cnki.1000-2707.2019.12.024.
21 Pietruszewski L, Moore-Clingenpeel M, Moellering GCJ, et al. Predictive value of the test of infant motor performance and the Hammersmith infant neurological examination for cerebral palsy in infants[J]. Early Hum Dev, 2022, 174: 105665. PMID: 36126506. DOI: 10.1016/j.earlhumdev.2022.105665.
22 邹林霞, 林小苗, 陈维华, 等. 基于NICU环境的早期干预对早产高危儿神经发育结局的影响[J]. 中国康复, 2017, 32(2): 136-137. DOI: 10.3870/zgkf.2017.02.015.
23 Vohr B, McGowan E, McKinley L, et al. Differential effects of the single-family room neonatal intensive care unit on 18- to 24-month Bayley scores of preterm infants[J]. J Pediatr, 2017, 185: 42-48.e1. PMID: 28238479. DOI: 10.1016/j.jpeds.2017.01.056.
24 黄静, 林新祝, 郑直, 等. 胎龄<32周且出生体重<1 500 g早产儿支气管肺发育不良的发生及其严重程度的影响因素[J]. 中国当代儿科杂志, 2022, 24(12): 1326-1333. PMID: 36544414. PMCID: PMC9785086. DOI: 10.7499/j.issn.1008-8830.2207013.
25 凌云, 王娟, 朱海虹, 等. 袋鼠式护理在支气管肺发育不良早产儿脱氧中的效果观察[J]. 浙江医学, 2020, 42(13): 1437-1438. DOI: 10.12056/j.issn.1006-2785.2020.42.13.2019-3416.