Abstract: Objective To investigate the effect of the quality improvement program on high-risk infants follow up (HRIF) clinic, in order to provide reference for improving the multidisciplinary follow-up system for high-risk preterm infants. Methods A total of 268 infants with gestational age<32 weeks or birth weight<1 500 g discharged from Tongji Hospital were recruited in a high-risk infant follow-up program from July 1st 2017 to July 31st 2018.Infants discharged in early period were defined as control group (n=185) and those discharged later were selected as intervention group (n=83).The control group was given conventional discharge guidance, while the intervention group received multidisciplinary HRIF.The follow-up rates of two groups at the corrected age of 1, 3, 6 months and Gesell score at the age of 6 months were compared. Results The follow-up rate of the intervention group and control group was not significantly different at the corrected age of 1 month(P>0.05), but the difference was significant at the age of 3 months and 6 months(χ²=5.307, 7.965, P<0.05).Infants in the intervention group had higher scores of cognitive and social functions assessed by Gesell scale at the corrected aged of six months (t=2.719, 3.661, P<0.05).Infants, who took regular follow-up at the corrected age of 1, 3, 6 months, had higher score in gross motor development and cognitive function than those without regular follow-up (F=8.486, 7.056, P<0.05). Conclusion The follow-up quality improvement program for high-risk infants increases the follow-up rate and indirectly facilitate the neurodevelopment of premature infants.

Key words: high-risk premature infants, premature infants, newborn, follow up, quality improvement

摘要： 目的 分析实施高危早产儿随访质量改进的效果, 为完善多学科合作的早产儿随访体系提供参考。方法 选取2017年7月1日-2018年7月31日, 从同济医院新生儿科出院的出生胎龄<32周和(或)出生体重<1 500 g的早产儿共268例, 纳入高危新生儿随访项目, 早期随访患儿为对照组(n=185), 给与常规出院指导与随访, 后期随访患儿为干预组(n=83), 实行随访质量改进措施, 比较两组高危早产儿在纠正月龄1个月、3个月及6个月的随访率以及6月龄Gesell 评分。结果 干预组和对照组患儿随访率在纠正月龄1个月时差异无统计学意义(P>0.05), 在3个月、6个月时干预组随访率均较对照组增高, 且差异有统计学意义(χ²＝5.307、7.965, P<0.05);纠正月龄6个月时干预组应物能和应人能得分高于对照组, 差异有统计学意义(t=2.719、3.661, P<0.05)。纠正月龄1个月、3个月及6个月均规律随访的早产儿, 其在大运动及应物能方面得分均高于未按规律随访的患儿(F＝8.486、7.056, P<0.05)。结论 高危早产儿随访质量改进可提高随访率, 间接促进早产儿的神经系统发育。

关键词: 高危早产儿, 早产儿, 新生儿, 随访, 质量改进