极低出生体重儿家庭参与式照护方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2024.24.002

摘要/Abstract

摘要：

目的构建全面、适用于极低出生体重儿的家庭参与式照护方案，并探讨该方案的应用效果。方法通过半结构式访谈、文献回顾、专家论证法构建极低出生体重儿家庭参与式照护方案。采用非同期对照试验，便利选取2023年1月—5月上海市某三级甲等儿童专科医院NICU收治的35例极低出生体重儿及其父母作为试验组，采用极低出生体重儿家庭参与式照护方案进行护理，保证父母每天参与照护的时间≥6 h，至少干预3 d。选取2022年1月—5月收治的35例极低出生体重儿及其父母作为对照组，采用NICU常规护理。比较两组住院期间体重增长速度、母乳喂养天数、出院时宫外发育迟缓发生率、晚发型败血症发生率、纠正胎龄37周时婴儿运动能力测试（Test of Infant Motor Performance，TIMP）评分<同胎龄早产儿TIMP评分第25百分位数的比例、住院天数等指标。结果邀请8名新生儿临床护理及护理管理专家进行专家论证，其权威系数为0.925。方案终稿包括准备和实施2个阶段，团队组建与培训、环境支持、评估、父母培训、实施家庭参与式照护、同伴支持、充分沟通7个主题。方案应用过程中，无脱落病例。应用结果显示，试验组体重增长速度快于对照组、母乳喂养天数多于对照组、出院时宫外发育迟缓发生率低于对照组，差异具有统计学意义（均P<0.05）。其余指标比较，差异无统计学意义（均P>0.05）。结论该研究构建的极低出生体重儿家庭参与式照护方案具有科学性、全面性和可行性。实施该方案可促进患儿体重增长及母乳喂养、降低出院时宫外发育迟缓发生率，且未增加晚发型败血症发生率。

关键词: 婴儿, 极低出生体重, 家庭参与式照护, 重症监护病房, 新生儿, 儿科护理学

Abstract:

Objective To develop a comprehensive family integrated care program for very low birth weight infants and to investigate the initial application effect of the program. Methods The family integrated care program for very low birth weight infants was developed using semi-structured interviews，a comprehensive literature review，and an expert consensus. A non-synchronous controlled trial was subsequently carried out. Between January and May 2023，35 participants accompanied by their parents for a minimum of 6 hours daily over a span of at least 3 days，were consecutively selected as an intervention group. Between January and May 2022，35 participants in the control group were treated with routine closed neonatal intensive care unit model. The application effect of the program on the clinical outcomes of very low birth weight infants was assessed，such as weight gain rate during hospitalization，breastfeeding days，incidence of late-onset sepsis，incidence of extrauterine growth restriction at discharge，TIMP level at corrected gestational age of 37 weeks and hospitalization days. Results The authority coefficient of the 8 invited experts specializing in neonatal nursing and nursing management was 0.925. A comprehensive program was developed，consisting of 2 stages—preparation and implementation，and addressing 7 key themes：staff team formation and training，environmental support，assessment，parental training，family-integrated care implementation，peer support，and comprehensive communication. No shedding cases occurred during the application of the program. The outcomes indicated that the intervention group experienced a higher rate of weight gain and more days of breastfeeding compared to the control group，and the incidence of extrauterine growth retardation upon discharge was also lower，with statistically significant differences（all P<0.05）. However，there were no significant differences in other clinical outcomes（all P>0.05）. Conclusion The family integrated care program for very low birth weight infants developed in this study is scientifically grounded，comprehensive，and practical. The implementation of this program can promote the weight gain and breastfeeding among very low birth weight infants，reduce the occurrence of extrauterine growth restriction upon discharge，and does not increase the incidence of late-onset sepsis.

Key words: Infant, Very Low Birth Weight, Family Integrated Care, Intensive Care Units, Neonatal, Pediatric Nursing

裘梦凡, 张艺, 李丽玲, 曹云, 窦亚兰, 胡晓静. 极低出生体重儿家庭参与式照护方案的构建及应用研究[J]. 中华护理杂志, 2024, 59(24): 2957-2965.

QIU Mengfan, ZHANG Yi, LI Liling, CAO Yun, DOU Yalan, HU Xiaojing. Construction and application of a family integrated care program for very low birth weight infants in China[J]. Chinese Journal of Nursing, 2024, 59(24): 2957-2965.

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参考文献 39

[1]	Pricoco R, Mayer-Huber S, Paulick J, et al. Impact of a family-centred clinical care programme on short-term outcomes of very low-birth weight infants[J]. Acta Paediatr, 2023, 112(11):2368-2377.
[2]	O’Brien K, Bracht M, MacDonell K, et al. A pilot cohort analytic study of family integrated care in a Canadian neonatal intensive care unit[J]. BMC Pregnancy Childbirth, 2013, 13(Suppl 1):S12.
[3]	傅亚丽, 张先红, 李禄全, 等. NICU医护人员对家庭参与式护理的认知与实践调查[J]. 中华护理杂志, 2021, 56(12):1806-1812. DOI URL
	Fu YL, Zhang XH, Li LQ, et al. Investigation on the cognition and practice of family-integrated care among medical staff in NICU[J]. Chin J Nurs, 2021, 56(12):1806-1812. DOI URL
[4]	沈婷, 冯世萍, 曹清, 等. 极低出生体重儿开放式探视的可行性研究[J]. 中华护理杂志, 2017, 52(10):1163-1167.
	Shen T, Feng SP, Cao Q, et al. Evaluation of effects of open visiting in very-low-birth-weight infants[J]. Chin J Nurs, 2017, 52(10):1163-1167.
[5]	刘欣, 卢淑亚. 家庭参与式早产儿预出院病房的建立及效果评价[J]. 中华护理杂志, 2019, 54(5):704-708. DOI URL
	Liu X, Lu SY. Establishment of pre-discharge ward for premature infants based on family integrated care model[J]. Chin J Nurs, 2019, 54(5):704-708. DOI URL
[6]	Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal,pediatric,and adult ICU[J]. Crit Care Med, 2017, 45(1):103-128. PMID
[7]	中华医学会儿科学分会新生儿学组, 中华新生儿科杂志编辑委员会, 中国医药教育协会新生儿护理分会. .早产儿围出院期管理专家共识(医护版)[J]. 中华新生儿科杂志, 2022, 37(5):385-394.
	Neonatology Group of Pediatric Branch of Chinese Medical Association,Editorial Committee of Chinese Journal of Neonatology, Neonatal Nursing Branch of China Medical Pharmaceutical Education Association. Management on safe discharge for preterm infants(medical staff version):experts consensus[J]. Chin J Neonatol, 2022, 37(5):385-394.
[8]	Pillai A, Pournami F, Prabhakar J, et al. Effect of early parent participation program on physiological stability in preterm infants:a randomized controlled trial[J]. Am J Perinatol, 2022, 39(16):1796-1804.
[9]	O’Brien K, Robson K, Bracht M, et al. Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes:a multicentre,multinational,cluster-randomised controlled trial[J]. Lancet Child Adolesc Health, 2018, 2(4):245-254.
[10]	Yu WC, Chiang MC, Lin KC, et al. Effects of maternal voice on pain and mother-Infant bonding in premature infants in Taiwan:a randomized controlled trial[J]. J Pediatr Nurs, 2022, 63:e136-e142.
[11]	Kurniawati, Rustina Y, Budiati T. Peer support increases maternal confidence,kangaroo mother care implementation and weight gain in LBW infants[J]. Compr Child Adolesc Nurs, 2019, 42(Suppl 1):252-260.
[12]	Fratantoni K, Soghier L, Kritikos K, et al. Giving parents support:a randomized trial of peer support for parents after NICU discharge[J]. J Perinatol, 2022, 42(6):730-737. DOI PMID
[13]	Zheng WJ, Chotipanvithayakul R, Ingviya T, et al. Sensory stimulation program improves developments of preterm infants in Southwest China:a randomized controlled trial[J]. Front Psychol, 2022, 13:867529.
[14]	Pineda R, Roussin J, Kwon J, et al. Applying the RE-AIM framework to evaluate the implementation of the supporting and enhancing NICU sensory experiences(SENSE) program[J]. BMC Pediatr, 2021, 21(1):137.
[15]	Chen HY, Dong L. The effect of family integrated care on the prognosis of premature infants[J]. BMC Pediatr, 2022, 22(1):668. DOI PMID
[16]	Hei MY, Gao XY, Li Y, et al. Family integrated care for preterm infants in China:a cluster randomized controlled trial[J]. J Pediatr, 2021, 228:36-43.e2.
[17]	Murdoch J, Hauck Y, Aydon L, et al. When can I hold my baby? An audit of time to first cuddle for preterm babies(<32 weeks) pre introduction and post introduction of a family-integrated care model[J]. J Clin Nurs, 2021, 30(23/24):3481-3492.
[18]	Kirolos S, Sutcliffe L, Giatsi Clausen M, et al. Asynchronous video messaging promotes family involvement and mitigates separation in neonatal care[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(2):172-177.
[19]	Martínez-Shaw ML, Sánchez-Sandoval Y. Effective stress intervention programs for parents of premature children:a systematic review[J]. Stress Health, 2023, 39(2):236-254.
[20]	Li YW, Zhang J, Yang C, et al. Effects of maternal sound stimulation on preterm infants:a systematic review and meta-analysis[J]. Int J Nurs Pract, 2023, 29(2):e13039.
[21]	Dol J, Delahunty-Pike A, Anwar Siani S, et al. eHealth interventions for parents in neonatal intensive care units:a systematic review[J]. JBI Database System Rev Implement Rep, 2017, 15(12):2981-3005.
[22]	North K, Whelan R, Folger LV, et al. Family involvement in the routine care of hospitalized preterm or low birth weight infants:a systematic review and meta-analysis[J]. Pediatrics, 2022, 150(Suppl 1):e2022057092O.
[23]	Maleki M, Mardani A, Harding C, et al. Nurses’ strategies to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit:a systematic review and meta-analysis[J]. Womens Health, 2022, 18:17455057221104674.
[24]	Van Veenendaal NR, Deierl A, Bacchini F, et al. Supporting parents as essential care partners in neonatal units during the SARS-CoV-2 pandemic[J]. Acta Paediatr, 2021, 110(7):2008-2022.
[25]	McAndrew NS, Jerofke-Owen T, Fortney CA, et al. Systematic review of family engagement interventions in neonatal,paediatric,and adult ICUs[J]. Nurs Crit Care, 2022, 27(3):296-325.
[26]	周爱玲, 刘辉, 齐慧. 家庭参与式护理对早产儿父母心理状况影响的系统评价[J]. 中华现代护理杂志, 2022, 28(35):4933-4938.
	Zhou AL, Liu H, Qi H. Effect of family integrated care on the psychological status of parents of premature infants:a systematic review[J]. Chin J Mod Nurs, 2022, 28(35):4933-4938.
[27]	Liwang F, Nadobudskaya DU, Lestari I, et al. Preterm infant physiological responses to music therapy:a systematic review[J]. Paediatr Indonesiana, 2018, 58(5):242-251.
[28]	Provenzi L, Broso S, Montirosso R. Do mothers sound good? A systematic review of the effects of maternal voice exposure on preterm infants’ development[J]. Neurosci Biobehav Rev, 2018, 88:42-50. DOI PMID
[29]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence recommendation level system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[30]	向希盈, 李颖, 李卓颖, 等. 中国新生儿重症监护病房中实施家长参与早产儿住院期间综合管理与常规护理平行对照研究[J]. 中国循证儿科杂志, 2016, 11(3):177-181.
	Xiang XY, Li Y, Li ZY, et al. Feasibility study of family-integrated-care in neonatal intensive care units in China:a parallel controlled trial[J]. Chin J Evid Based Pediatr, 2016, 11(3):177-181.
[31]	Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5 Pt 1):986-990. PMID
[32]	Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants[J]. BMC Pediatr, 2013, 13:59. DOI PMID
[33]	中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019年版)[J]. 中华儿科杂志, 2019, 57(4):252-257.
	Neonatology Group of Pediatric Branch of Chinese Medical Association,Infection Committee of Neonatology Physicians Branch of Chinese Medical Doctor Association. Expert consensus on the diagnosis and management of neonatal sepsis(version 2019)[J]. Chin J Pediatr, 2019, 57(4):252-257.
[34]	屈福祥. 婴儿运动表现测试中国常模及其信效度的研究[D]. 重庆: 陆军军医大学, 2022.
	Qu FX. Study on China norm of Infant Sports Performance Test and its reliability and validity[D]. Chongqing: Army Medical University, 2022.
[35]	周瑞茜, 倪王平, 柯若, 等. 家庭参与式护理模式下支气管肺发育不良早产儿2岁内再入院的影响因素分析[J]. 中华护理杂志, 2022, 57(12):1481-1485. DOI URL
	Zhou RX, Ni WP, Ke R, et al. Risk analysis of readmission of preterm infants with bronchopulmonary dysplasia within 2 years of age based on the family participatory care model in the NICU[J]. Chin J Nurs, 2022, 57(12):1481-1485. DOI URL
[36]	黑明燕, 高翔羽, 李占魁, 等. 新生儿重症监护病房家庭参与式管理模式中的母乳喂养结局研究[J]. 中华新生儿科杂志, 2018, 33(1):27-33.
	Hei MY, Gao XY, Li ZK, et al. Breastfeeding outcomes in family integrated care model in neonatal intensive care units[J]. Chin J Neonatol, 2018, 33(1):27-33.
[37]	黄婷, 郑剑煌, 林春燕. 感官刺激对早产儿神经发育影响的研究进展[J]. 中华护理杂志, 2023, 58(12):1456-1461. DOI URL
	Huang T, Zheng JH, Lin CY. Research progress on the effect of sensory stimulation on neural development of premature infants[J]. Chin J Nurs, 2023, 58(12):1456-1461. DOI URL
[38]	杭琳, 张洁苹, 项丹玉, 等. 基于共同养育理论的母乳喂养支持方案在NICU早产儿医院-家庭过渡期中的应用[J]. 中华护理杂志, 2023, 58(12):1435-1441. DOI URL
	Hang L, Zhang JP, Xiang DY, et al. Application of an intervention based on co-parenting theory on hospital-home transitional breastfeeding of NICU preterm infants[J]. Chin J Nurs, 2023, 58(12):1435-1441. DOI URL
[39]	Synnes AR, Petrie J, Grunau RE, et al. Family integrated care:very preterm neurodevelopmental outcomes at 18 months[J]. Arch Dis Child Fetal Neonatal Ed, 2022, 107(1):76-81.