Objective To evaluate the effects of the second phase of Neonatal Resuscitation Program (NRP) in China. Methods A mail survey and an onsite assessment were conducted to collect data. (1) Mail survey: Different levels of domestic hospitals (except those in Tibet, Hong Kong, Macao and Taiwan) were randomly selected to collect information on in-hospital NRP training, resuscitation equipments, incidence of birth asphyxia and neonatal mortality caused by birth asphyxia from year 2010 to 2014. (2) Onsite assessment: One provincial level, two prefecture level and two county level hospitals or healthcare institutions were randomly selected in four provinces. A questionnaire survey was conducted among randomly selected health workers including midwives, obstetricians and pediatricians. Megacode performance of those health workers was evaluated. Trend Chi-square test was used for statistical analysis. Results (1) Questionnaires were gathered from 347 hospitals via the mail survey with a response rate of 74.6% (347/465). In the 347 hospitals, 97.5% (10410/10674) of the obstetricians, paediatricians, and midwives received in-hospital training, and 72.7% (7765/10674) of them received training from county or above level. (2) In the onsite assessment of the four provinces, 205 health workers were randomly selected and completed the questionnaire survey. Among them, 85.4%(175/205) received training more than three times, 52.7% (108/205) received over two days of training in the previous training workshops, but only 62.0% (127/205) could share one set of training manikin with less than eight trainees in training workshops. Megacode performance of 96 health workers was evaluated. The results showed that all of the health workers were qualified in terms of total score and achieved an average score of over 1.5 in the performance of every primary resuscitation skill. Health workers attained relatively high scores in performing initial steps in resuscitation and tracheal intubation, and in identifying the indication of chest compression and epinephrine administration. However, their average scores in preparation for resuscitation, positive pressure ventilation and teamwork were relatively low. (3) Over 90% of the 347 hospitals had basic resuscitation equipment such as neonatal bag and mask, devices for tracheal intubation and radiation warmer. But fewer were equipped with umbilical venous catheter, T-piece or oxygen-air blender, especially at the county level hospitals. The incidence of neonatal asphyxia decreased from 2.33%(7810/335190) in 2010 to 1.79%(9227/515481) in 2014. The mortality from asphyxia at birth decreased from 2.41 to 1.64 per 10000 live births [(81/335190) and (85/515481)]. Trend analysis revealed that the incidence of neonatal asphyxia (χ2trend=20.56, P<0.01) and the mortality at birth (χ2trend=77.34, P<0.01) declined over time. Conclusions The second phase of NRP has promoted the generalization of the neonatal resuscitation technology and resulted in decreased incidence of asphyxia and asphyxial mortality. Future programs should focus on measures to improve practical skills and teamwork, to increase the allocation of resuscitation equipment and to strengthen trainings among obstetricians and midwives.

新生儿窒息是导致全世界新生儿死亡、脑性瘫痪和智力障碍的主要原因之一.据统计,每年全世界大约有 400 万新生儿死亡,其中 23% 死于出生窒息 [1].为降低新生儿窒息的死亡率和伤残率,1987 年美国儿科学会和美国心脏协会开发了新生儿复苏项目.我国妇幼卫生监测显示,2005 年中国新生儿死亡率为 19.0‰.前 3 位死因依次为早产和低体重、窒息、肺炎 [1].

近年来,随着新生儿重症监护及抢救技术的提高,国内外极低出生体重儿(very low birth weight infant,VLBWI) 和 超 低 出 生 体 重 儿(extremely low birth weight infant,ELBWI)的抢救存活率和生存质量得到了很大提高,但其各系统器官极不成熟,易发生各种损伤,需关注其产前管理、出生时复苏和生后的早期救治.特别是 ELBWI,几乎均需要在出生时给予复苏支持,且易发生严重的近、远期并发症,甚至死亡.

窒息缺氧胎盘血流阻断时为保证心脑供血会导致心输出量重新分布而引起其他脏器的损害，窒息持续加重时形成严重代谢性酸中毒（pH≤7），并导致心脑损害[1]。窒息酸中毒引起新生儿主动脉舒张压下降，促使冠状动脉收缩使心脏灌注及全身灌注不足，不仅心脏缺血缺氧加重，还进一步累及各器官的灌注压而发生损害[2-6]。但是目前，国内外尚无新生儿窒息多器官损害的多中心研究，更无公认的诊断标准、常规或指南。在清华大学自主科研基金资助下，全国新生儿窒息多器官损害临床诊断多中心研究协作组（简称协作组）成立，提出结合Apgar评分和出生时脐动脉血pH诊断新生儿窒息，及新生儿窒息多器官损害的诊断标准[7]，并根据此标准进行了新生儿窒息多器官损害的多中心前瞻性研究[8-9]。研究结果认为该新生儿窒息多器官损害的临床诊断标准[7]较全面，且更深入，具有较好的临床意义，现对该诊断标准进行解读，以指导临床实施。

新生儿窒息是导致全世界新生儿死亡、脑性瘫痪和智力障碍的主要原因之一。据统计每年全世界大约400万新生儿死亡中23%死于出生窒息。根据我国妇幼卫生监测显示：我国2005年新生儿死亡率为19.0‰。前三位的死因为：早产和低体重、窒息、肺炎。窒息占第二位。多年来，我国新生儿复苏的水平与发达国家有较大的差距，2004年引进新生儿复苏项目以来，形势发生了巨大的变化。现就近10年来我国新生儿复苏工作的情况和今后的任务做一述评。

目前，国内外尚无新生儿窒息多器官损害的多中心研究，更无公认的诊断标准、常规或指南。在清华大学自主科研基金资助下，全国新生儿窒息多器官损害临床诊断多中心研究协作组成立，制定了本标准。

This study aimed to study the feasibility, efficacy and safety of using laryngeal mask (LM) ventilation compared with endotracheal intubation (ETI) during neonatal resuscitation.

>为推进我国的新生儿复苏工作,在广大围产医学工作者的共同要求和努力下,经中华医学会批准,中华医学会围产医学分会新生儿复苏学组(以下简称学组)正式成立,并于2014年5月24日在山东省济南市召开了第一次全体会议。会议首先由中华医学会组织部胡俊宣读新生儿复苏学组委员名单并颁发聘书,然后中华医学会围产医学分会主任委员杨慧霞教授和候任主任委员朱建幸教授先后致辞,他们

Objective Our goal was to investigate the relationship between angiotensin-converting enzyme gene insertion/deletion polymorphism and the insulin sensitivity in healthy newborns. Method One hundred eighty healthy newborns, all of whom had a 1-minute Apgar score of >7 and gestational age >33 weeks, were enrolled in the study. Fasting glucose and insulin levels were measured on day 2 or 3 after birth, and angiotensin-converting enzyme genotype was determined.Result The observed frequency distribution of angiotensin-converting enzyme genotypes did not deviate from that predicted by Hardy-Weinberg equilibrium in this group. There were no statistically significant differences in birth size and shape in different angiotensin-converting enzyme genotypes. Those carriers of the genotype homozygous for the deletion allele had the highest logarithmically transformed homeostasis model assessment (HOMA) compared with those who were heterozygous or homozygous for the insertion polymorphism. When compared with those with ≥1 insertion allele, those of the genotype homozygous for the deletion allele had significantly higher logarithmically transformed fasting insulin and logarithmically transformed homeostasis model assessment results. Regarding birth weight, birth length, ponderal index, and fasting glucose concentration, there were no significant differences between the genotype homozygous for the deletion allele and the genotypes heterozygous or homozygous for the insertion allele. Conclusion In this study, the deletion allele was associated with relatively impaired insulin sensitivity in healthy neonates. It may be a clue to explain the association between the deletion allele and insulin resistance in the long-term.

Objective To examine the effectiveness of simulation newborn simulator in neona-tal resuscitation training for pediatric residents. Methods From June 2011 to June 2012, 11 residents working in neonatal ward of the Third Hospital of Peking University were enrolled into the study. Eval-uation on the residents was made before the training. Training of simulated teaching using simulation newborn simulator was conducted and evaluation was made after the training. SPSS 18.0 was used for statistical analysis. Comparison was made between pre- and post-training test by paired t test. P<0.05 was considered statistical significant. Questionnaire survey was conduct to acquire residents' feedback. Results A total of 11 participants completed the training and finished the questionnaire. The score of pre-training was 37.82±1.17 versus that of post-training 39.18±0.87(t=4.89, P<0.01). All residents were satisfied with the simulation-based training. Conclusion Simulation training can improve pedi-atric residents' knowledge and skills in neonatal resuscitation.

国家卫生和计划生育委员会(简称国家卫计委)与美国强生公司合作开展的第二周期(2011年至2015年)新生儿复苏项目实施3年以来,各省、直辖市、自治区及新疆生产建设兵团积极开展相关工作,在项目管理、技术培训、制度建设等方面均取得了显著成效,积累了丰富的经验.为总结项目实施经验、提高各省师资的技术水平,受国家卫计委妇幼司委托,中国疾病预防控制中心妇幼保健中心于2013年7月24日至26日在北京召开了“第二周期新生儿复苏项目中期总结会暨省级师资培训班”。

新生儿窒息是导致全世界新生儿死亡、脑性瘫痪和智力障碍的主要原因之一.据统计,每年全世界大约400万死亡新生儿中23％死于出生窒息.1987年美国儿科学会和美国心脏协会开发了新生儿复苏项目并向全世界推广,因此大大降低了新生儿窒息的死亡率和伤残率.

OBJECTIVE:To evaluate an intervention package promoting effective neonatal resuscitation training at county level hospitals across China.METHODS:The intervention package was implemented across 4 counties and included expert seminars, training workshops, establishment of hospital-based resuscitation teams, and supervision of training by national and provincial instructors. Upon completing the activities, a survey was conducted in all county hospitals in the 4 intervention counties and 4 randomly selected control counties. Data on healthcare providers' knowledge and self-confidence, and incidence of deaths from birth asphyxia from 2009 to 2011 in all hospitals were collected and compared between the two groups.RESULTS:Eleven intervention and eleven control hospitals participated in the evaluation, with 97 and 87 health providers, respectively, completing the questionnaire survey. Over 90% of intervention hospitals had implemented neonatal resuscitation related practice protocols, while in control hospitals the proportion was less than 55%. The average knowledge scores of health providers in the intervention and control counties taking a written exam were 9.2±1.2 and 8.4±1.5, respectively (P<0.001) out of maximum possible score of 10, and the average self-confidence scores were 57.3±2.5 and 54.1±8.2, respectively (P<0.001). Incidence of birth asphyxia (defined as 1-min Apgar score≤7) decreased from 8.8% to 6.0% (P<0.001) in the intervention counties, and asphyxia-related deaths in the delivery room decreased from 27.6 to 5.0 per 100,000 (P=0.076). There was no difference over time in asphyxia rates for the control counties.CONCLUSIONS:The intervention has not only improved skills of health providers, decreased the mortality and morbidity of birth asphyxia, but also resulted in effective implementation of guidelines and protocols within hospitals.

为指导新生儿复苏,美国儿科学会和美国心脏协会制订了新生儿复苏指南,并在循证医学研究的基础上定期修订(每5年修订1次).2010年在循证医学研究的基础上制定了新生儿复苏指南(简称新指南)[1],2011年出版了第6版新生儿复苏教材(简称新教材)[2]和第5版新生儿复苏教师指导手册[3].新指南和新教材除了在内容上有一些改变外(见本期刊出的述评《新生儿复苏国际指南和教材的进展及国内实施策略》),在培训的教学方法上也做了重要改变,提出了“案例模拟和参与式反馈”的新教学方法.现将此新教学方法做一简单的介绍。

肠道病毒(enterovirus)是导致新生儿感染的常见病原体,可由母亲通过胎盘、产道感染新生儿,也可由母亲、医护人员在生后感染新生儿,或在新生儿间交叉感染,是医院感染的主要病原体之一.肠道病毒感染可以散发,也可以在新生儿室引起暴发流行,病死率高,常给家庭及社会造成严重的伤害,应引起重视.

Objective To study the feasibility,efficacy and safety of u tilizing the laryngeal mask airway (LMA) ventilation compared with the endotracheal intubation ( ET ) in neonatal resuscitation for moderate and severe asphyxiated neonates.Methods Neonates requiring positive pressure ventilation with heartrate ＜60 beats/min were collected and grouped quasi-randomizedly into LMA(36 cases) or ET(32 cases)ventilation.Differences of resuscitation effect,inserting time,successful once insertion rate and adverse reactions between the two groups were observed and compared.Results ( 1 ) No significant difference was observed in Apgar scores at 1 min and 5 min between the two groups ( P＞0.05 ).(2) Success rate of once insertion was 94.4％ with average inserting time ( 7.58±1.16 ) s for LMP group,while it was 90.6％ and ( 7.89 ± 1.52) s for ET group.( 3 ) Successful resuscitation rate of LMA group ( 86.11％ ) was slightly lower than ET group (96.88％ ),but there was no statistical difference (P＞0.05).(4) Mean response time of LMA group [ (34.06 ± 10.56) s] was slightly lower than that of ET group [ (41.38 ±27.19) s],also ventilation time of LMA group [( 137.19 ±80.14) s] was slightly lower than that of ET group [ ( 171.09±84.28 ) s ],but neither showed statistical difference ( P＞0.05 ).(5) Adverse reactions were found in LMA group including nausea( 2 cases )and abdominal distention (1 cases),while there were laryngeal edema( 1 cases),pneumothorax(2 cases),respiratory tract bleeding( 1 cases) in ET group.Conclusion The LMA ventilation is much easier to operate,with its effect no less than that of ET ventilation on resuscitation for moderate and severe asphyxiated cases,even it seems more safe.LMA ventilation can be a good substitute for ET ventilation,especially for those medical staffs who are unfamiliar with ET operation and primary hospital doctors in case of emergency.

我国卫生部与美国强生儿科研究院合作开展的新生儿复苏项目(2004年至2010年)开展以来,在全国范围内进行了以20个降低孕产妇死亡率和消除新生儿破伤风(简称降消)项目省为主的新生儿复苏培训工作.自2004年7月开始,先后举办了项目的国家级师资培训班、省级师资培训班及地、市、县培训班,培训工作已普及到县级。

Background Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.Methods The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces.Results Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10000 from 2003 to 2008, and the incidence of Apgar 57 at 1 minute decreased from 6.3% to 2.9%.Conclusions The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved. Chin Med J 2012;125(8):1448-1456

Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital. Key words: Asphyxia neonatorum; Resuscitation; Evaluation studies