1、早产儿管理现状与未来早产儿管理现状与未来Why pay special attention to preterm children早产儿是全球人类死亡的主要原因之一全世界每年超过300万新生儿死亡,并发症导致死亡病例中早产儿为35%儿童5岁以下肺炎死亡病例中,早产儿占位第二,在中高收入国家则占位第一早产儿也是人类生命过程中远期死亡重要原因Blencowe et al.Reproductive Health 2013,10(Suppl 1):S2Preterm baby survival and care round the world全球早产婴儿生存全球早产婴儿生存与管理状况与管理状况 Est
2、imated distribution of causes of 3.1 million neonatal deaths in 193 countries in 2010.Source:Updated from Lawn et al.,2005,using data from 2010 published in Liu L,et al.,2012.Blencowe et al.Reproductive Health 2013,10(Suppl 1):S2Figure 2.Increasing survival gap for preterm babies around the world:Re
3、gional variation in preterm birth as direct cause of neonatal deaths showing change between 2000 to 2010.Source:Born Too Soon,Chapter 5.Data from Child Health Epidemiology Reference Group and World Health Organization estimates of neonatal causes of death(Liu et al.2012).Figure 3.Preterm births by g
4、estational age and region for the year 2010.Based on Millennium Development Goal regions.Source:Reproduced with permission from Blencowe et al.(2012)National,regional and worldwide estimates of preterm birth rates in the year 2010 withtime trends since 1990 for selected countries:a systematic analys
5、is and implications.Lancet 379(9832):2162-2172.Lancet.2013 January 19;381(9862):223234.Overview of defi nitions for preterm birth and related pregnancy outcomes.Source:Reproduced with permission from Blencoweet al.(2012)National,regional and worldwide estimates of preterm birth rates in the year 201
6、0 with time trends since 1990 for selected countries:a systematic analysis and implications.Lancet 379(9832):2162-2172.The The history of history of neonatal neonatal care in care in the United the United Kingdom Kingdom and the and the United United States States shows that shows that dramatic dram
7、atic declines declines in in neonatal neonatal mortality mortality are are possible possible even even before before neonatal neonatal intensive intensive care is care is scaled upscaled up.Source:Born Too Soon,Chapter 5 113.Acroynms used:ANCS=antenatal.Program opportunities for scale up of the care
8、专业规模发展将带专业规模发展将带来空间提升来空间提升Figure 1.135 million newborns and 15 million premature babies-health system needs and human capital outcomes around the year2010.Source:Born Too Soon report,chapter 5 113.Analysis using data from Blencowe et al.,2012 1;Cousens et al.,2011 114;Liu et al.,2012 8.专业规模发展将带来提升空间
9、专业规模发展将带来提升空间 Program opportunities for scale up of care许多大覆盖的早产儿数据缺乏,无法为提升干预水平提供基础证据,包括高收入的国家,故很难评估全球早产儿管理状况或几个重要新生儿干预项目实施情况National coverage data for many of the evidence-based interventions for premature babies are lacking even in high-income settings,hence it is difficult to assess the global si
10、tuation for care of premature babies or indeed for several important newborn care interventionsReprod Health.2013;10(Suppl 1):S5.Missed opportunities to reach preterm babies with Missed opportunities to reach preterm babies with essential interventions,median for Countdown to 2015 essential interven
11、tions,median for Countdown to 2015 priority countriespriority countries.Source:Born Too Soon,Chapter 5.Data sources:Adapted(Kinney et al.,2010)using data from UNICEF Global Databases.What shuold we do nextWhat shuold we do next赢得机遇推动早产与赢得机遇推动早产与早产儿医学发展早产儿医学发展推动与发展策略推动与发展策略早产管理早产管理:监测与预警监测与预警,预防与治疗预防
12、与治疗提高早产儿复苏水平提高早产儿复苏水平建立等级技术平台建立等级技术平台,提升不同重症监护提升不同重症监护病房技术水平病房技术水平加强早产儿入院前与出院后管理加强早产儿入院前与出院后管理架构家长教育体系架构家长教育体系,达成社会共识达成社会共识程序程序1 基础与额外护理基础与额外护理 体温管理 喂养支持 预防感染程序程序2 早产儿复苏程序程序3 袋鼠式护理程序程序4 特殊护理及重症监护特殊护理及重症监护感染黄疸呼吸窘迫综合征等Percentage of infants with 7-day readmissions according to year of birth.Hosp Pediat
13、r.2013 January;3(1):715.Barriers and facilitators to Barriers and facilitators to preparing families for neonatal preparing families for neonatal dischargedischarge研究与实践策略研究与实践策略建立早产与早产儿网络平台及协作体系建立早产与早产儿网络平台及协作体系获得本领域流行病学资料获得本领域流行病学资料在不同层面进行大数据主题研究在不同层面进行大数据主题研究各领域实验技术及诊疗方案精细化管理各领域实验技术及诊疗方案精细化管理学科间跨界延伸与创新学科间跨界延伸与创新
