Neonatal-Perinatal Health Care Delivery: Epidemiology/Health Services Research
Neonatal-Perinatal Health Care Delivery 1: Practices: Antenatal Consultation, Substance Use, Potpourri
Sabah Pirwani, Bachelor of Health Sciences (BHSc) (she/her/hers)
Graduate Researcher
McGill University
Montreal, Quebec, Canada
Jo-Anna Hudson, MD PhD
Fellow
University of Ottawa, Department of PEdiatrics, Division of Neonatology
University of Ottawa Faculty of Medicine
Ottawa, Ontario, Canada
Victoria S. Bizgu, MD, PhD. (she/her/hers)
Jewish General Hospital
Montreal, Quebec, Canada
Neonatal Intensive Care Unit (NICU) organizational factors such as nurse-to-patient ratios (NPRs) may contribute to patient outcomes.
Objective:
To examine the association of NPR on the shift of admission, first 24h and 72h of admission and the risk of mortality or major morbidity among very preterm infants.
Design/Methods:
This was a multicenter prospective cohort study of infants born < 33 weeks in 14 tertiary-level NICUs (inborn) in Canada between January 2020-December 2021. Data on infant characteristics, NPRs and outcomes were obtained from the Canadian Neonatal Network database. For each infant, the NPRs received were recorded 4 times per day and an average NPR was calculated for shift of admission, first 24h and 72h of admission. Primary outcome was mortality or major morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, nosocomial infection, and severe retinopathy of prematurity). Odds ratios were estimated using multivariable logistic regression models adjusted for gestational age, sex, small for gestational age, SNAP-II score >20, and mode of ventilation on admission, with generalized estimating equations to account for clustering within each site. Planned subgroup analyses included infants of 29-32 weeks and < 29 weeks.
Results:
Among 2453 infants included in the study population, 913 (37%) died or developed a major morbidity (Table 1). The median NPR was 0.5 [IQR 0.5-1.0] on shift of admission, 0.5 [IQR 0.5-0.7] in the first 24h and 0.56 [IQR 0.5-0.7] in the first 72h of admission. Overall, NPRs on shift of admission, first 24h and 72h of admission were not associated with mortality/morbidity (Table 2). In the subgroup of infants born < 29 weeks, there was an association between higher NPRs on shift of admission with lower odds of mortality/morbidity (adjusted Odds Ratio (aOR); 0.52, 95% CI 0.28-0.97) (Table 2) and lower odds of bronchopulmonary dysplasia and necrotizing enterocolitis (Table 3). An association was also observed between higher NPR in the first 72h of admission with increased odds of severe neurological injury (aOR 2.78, 95% CI 1.18, 6.55) (Table 3). Additional subgroup analysis among infants born < 26 weeks showed similar results (Table 2).
Conclusion(s):
Higher NPRs were not associated with mortality/morbidity among infants born < 33 weeks. Higher NPRs on admission were independently associated with lower odds of mortality/major morbidity among infants < 29 weeks. The absence of association of NPRs in the first 24h and 72h of admission with outcomes is likely due to confounding by indication with sicker infants receiving higher NPRs.