Aplicación de un modelo global de mejora de calidad en la reanimación del recién nacido pretérmino menor de 32 semanas de edad gestacional en sala de partos

Abstract

Objective To know the association between the introduction of a package of several quality care tools during neonatal resuscitation (CPR) of preterm infants under 32 weeks of gestational age (<32wGA) and the effectiveness of initial stabilization, absence of problems in the execution of the procedure and short-term clinical evolution of this group of children. The tools studied were: random real-time safety audits (RRTSAs) of neonatal resuscitation (CPR) posts in the delivery room and transport incubator, use of checklists, and perform of briefing and debriefing meetings before and after the procedure. To explore the feasibility of its introduction and the satisfaction of healthcare personnel with its use. Material and methods An interventional, quasi-experimental, prospective and multicenter study was carried out in five level III-A neonatal units (NICU) in Madrid. In the pre-intervention period, which lasted one year, weekly RRTSAs were performed on at least three resuscitation posts in the delivery room and the transport incubators, and various clinical variables were collected in newborns <32wGA during stabilization, upon admission and throughout their hospital stay. The clinical variables established as main objectives were: the knowledge of oxygen saturation (SatO2) at three minutes of life, the need for intubation in the delivery room, and the axillary temperature of the newborn on admission to the NICU. The data obtained in this phase were compared to those collected in the post-intervention period, lasting another year, which was carried out after introducing the other quality care tools, collecting the data with the same methodology. Satisfaction with the use of all these tools was explored through surveys carried out on healthcare personnel during the two periods of the study. Results Data from 75 preterm newborns <32wGA were analyzed in the pre-intervention phase and 48 in the post-intervention period. Both groups were homogeneous in terms of gestational age and birth weight, demographic variables, maternal-fetal pathology, or prenatal care. The global package of care tools was used in 75% of the CPRs in the post-intervention period. No statistically significant differences were found in the knowledge of SatO2 at 3 minutes of life (79.7% of CPR in the pre-intervention period, vs 79.1% of the post-intervention period, p = 0.468), need for intubation in delivery room (9.3% vs 18.7%, p = 0.612) nor the axillary temperature on admission (36.5 ºC vs 36.4 ºC, p = 0.799). There were also no significant differences in other clinical variables analyzed and the evolution of the two groups of premature infants during their admission was very similar, with an analogous percentage of premature infants with serious sequelae in both phases of the study (12.5% vs 10.9%, p = 0.789). A trend was observed, without statistical significance, towards a lower percentage of CPR with technical problems in the post-intervention phase (14.7% vs 6.2%, p=0.151). Regarding the RRTSAs, 852 audits of the CPR posts were carried out in the pre-intervention period and 877 in the post-intervention period, in addition to 237 RRTSAs of the transport incubators in the first phase and 255 in the second. Significant differences were found between the two periods in the percentage of RRTSAs without defect of the CPR posts (62.7% [95% IC: 59.4-65.9] vs 81.1% [95% IC: 78.5-83.7] p<0,001) without differences in the percentage of audits without defect of the transport incubators (94.9% vs 91.2%, p = 0.218). After analyzing the results of 200 surveys carried out in the first phase and 155 in the second, significant results (p <0.001) were obtained in all the variables analyzed. The healthcare personnel showed a high degree of satisfaction with the introduction of these tools and a perception of higher quality, better coordination and greater degree of personal comfort with the procedure in CPR carried out during the post-intervention period. Conclusion The introduction of a global package of tools for quality of care in the stabilization of the premature infant <32wGA at birth (RRTSAs, checklists, briefings and debriefings) is feasible and improves the perception of quality and coordination of CPR in the resuscitation team, although it has no influence on the execution of the procedure or in the short-term clinical course of these newborns. The use of RRTSAs of the resuscitation stations in the delivery room significantly improves their preparation.