Khalid Aziz1, Xiaolu Ma2, Jocelyn Lockyer3, Douglas McMillan4, Xiang Y Ye5, Lizhong Du2, Shoo K Lee5,6, Nalini Singhal3. 1. Department of Paediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta. 2. Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China. 3. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta. 4. Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia. 5. Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario. 6. Faculty of Medicine, University of Toronto, Toronto, Ontario.
Abstract
BACKGROUND: The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada to train health care providers in the identification and management of newborns who are at-risk and/or become unwell after birth. The ACoRN process follows a stepwise framework that enables evaluation, decision, and action irrespective of caregiver experience. This study examined the hypothesis that the ACoRN educational program improved clinical practices and outcomes in China. METHODS: In a before-and-after study, ACoRN training was provided to physicians, neonatal nurses, and administrators in 16 county hospitals in Zhejiang, PRC. Demographic and clinical data were collected on babies admitted to neonatal units before (May 1, 2008 to March 31, 2009) and after (June 1, 2010 to April 30, 2012) training. RESULTS: A total of 4,310 babies (1,865 pre- and 2,445 post-training) from 14 sites were included. There were more in-hospital births (97.8% versus 95.6%, P<0.01) in the post-training epoch, fewer babies needing resuscitation (12.7% versus 16.0%, P=0.02), and more babies finishing their care in hospital (67.4% versus 53.1%, P<0.0001). After training, significantly more babies were evaluated as having respiratory distress at admission (14.2% versus 9.4%, P<0.0001); more babies had saturation, glucose and temperature measured on admission and at discharge; and more babies received intravenous fluids (86.3% versus 72.8%, P<0.0001). No significant improvements were noted in mortality (0.49% [post] versus 0.8% [pre], P=0.19 and adjusted odds ratio 0.54, 95% confidence interval: 0.23 to 1.29). CONCLUSIONS: ACoRN training significantly increased patient evaluations and changed clinical practices. However, we were unable to ascertain improvement in morbidity or mortality.
BACKGROUND: The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada to train health care providers in the identification and management of newborns who are at-risk and/or become unwell after birth. The ACoRN process follows a stepwise framework that enables evaluation, decision, and action irrespective of caregiver experience. This study examined the hypothesis that the ACoRN educational program improved clinical practices and outcomes in China. METHODS: In a before-and-after study, ACoRN training was provided to physicians, neonatal nurses, and administrators in 16 county hospitals in Zhejiang, PRC. Demographic and clinical data were collected on babies admitted to neonatal units before (May 1, 2008 to March 31, 2009) and after (June 1, 2010 to April 30, 2012) training. RESULTS: A total of 4,310 babies (1,865 pre- and 2,445 post-training) from 14 sites were included. There were more in-hospital births (97.8% versus 95.6%, P<0.01) in the post-training epoch, fewer babies needing resuscitation (12.7% versus 16.0%, P=0.02), and more babies finishing their care in hospital (67.4% versus 53.1%, P<0.0001). After training, significantly more babies were evaluated as having respiratory distress at admission (14.2% versus 9.4%, P<0.0001); more babies had saturation, glucose and temperature measured on admission and at discharge; and more babies received intravenous fluids (86.3% versus 72.8%, P<0.0001). No significant improvements were noted in mortality (0.49% [post] versus 0.8% [pre], P=0.19 and adjusted odds ratio 0.54, 95% confidence interval: 0.23 to 1.29). CONCLUSIONS: ACoRN training significantly increased patient evaluations and changed clinical practices. However, we were unable to ascertain improvement in morbidity or mortality.
Keywords:
ACoRN; Acute Care of at-Risk Newborns; Continuing education; Continuing professional development; Life support course; Newborn; Newborn stabilization
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