Abstract
Background/Aims: Clinical protocols based on available evidence and supported by wide staff consensus are considered an effective means to introduce potentially better practices in the diagnosis/treatment of medical conditions. In the management of neonatal shock, a wide variability has been observed. This study aims to determine the level of compliance with a neonatal shock protocol and to identify reasons of non-compliance.
Methods: After extensive review of the literature, full agreement was reached among medical staff of a third level neonatal unit on a revised protocol for the management of neonatal shock. The protocol, introduced in 2002, identified different steps: The first was fluid infusion; the second, if no response was elicited, was to use a specific sequence of vasopressor drugs, quiet different from the sequence in the previous protocol. In all patients with a codified neonatal shock during 2004, diagnostic work-up and treatment interventions registered in medical records were compared with protocol recommendations.
Results: 43 episodes of neonatal shock were identified in 42 patients. Fluid infusion was administered as the first intervention in 20/43; further treatment was applied to control the shock episode in 10/20, and in all of them (10/10) vasopressor drugs were administered according to protocol. Taking into account both steps, 46.5% of the shock episodes were managed according to the new protocol. When the initial treatment recommendation was not fulfilled, drugs were administered according to the new protocol sequence in 16/23 (70%); following the previous protocol in 3/23. When a transfusion was administered, protocol criteria were fulfilled in 50% of the episodes. Calcium was controlled only in 6/43,(14%).
Conclusions: In nearly half the episodes of neonatal shock, clinical practice complies with the recommendations of a revised protocol which raised full staff consensus. Only in very few cases were deviations from protocol caused by compliance with the previous one.
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Marín Gabriel, M., Alonso Díaz, C., Pallás Alonso, C. et al. 227 Neonatal Shock: Protocol Compliance. Pediatr Res 58, 393 (2005). https://doi.org/10.1203/00006450-200508000-00256
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DOI: https://doi.org/10.1203/00006450-200508000-00256