Very premature babies: the busier the intensive care unit, the greater the risk

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Very premature infants: the busier the intensive care unit, the greater the risk

Very premature babies have fragile health that requires constant vigilance.

The more the neonatal intensive care unit is busy, the more the risk of complications increases for very premature babies, concludes a study carried out by Quebec researchers.

The risk of serious complications reaches 45% when all the beds are occupied, the study states.

In comparison, the percentage of serious complications is 30% when half of the beds are occupied. It increases to 40% when eight out of ten beds are occupied, and to 50% when the intensive care unit is at 110% capacity.

We knew that the units which were very busy overall had worse results by comparing them to each other, told The Canadian Press first doctor Bruno Piedboeuf, of the Center de recherche du CHU de Québec-Université Laval.

“But there, even within the same unit, we see that when it's busier, the rates complications are higher. »

— Bruno Piedboeuf, from the CHU de Québec-Laval University Research Center

This association could be attributable to the lack of staff, the study authors believe. Extremely premature babies have fragile health that requires constant vigilance and a rapid response when needed. A ratio of one nurse per baby would be required for optimal care.

The data analyzed by the researchers, however, shows a modest negative association between intensive care unit traffic and the number of nurses on the floor, compared to the recommended number – in other words when the traffic increased, the number of nurses decreased.

Despite this, 75% of the shifts studied could count on at least 89% of the recommended number of nurses, which could limit the assessment of the impact of a staff shortage, the researchers write. It also does not take into account the experience of the staff in place.

We come to compensate for the (high) occupancy rates by adding more nurses, but we finally realize that this does not make it possible to correct the entire problem, analyzed Doctor Piedboeuf.

“Nurses are important, but we can't fully compensate. »

— Bruno Piedboeuf, from the CHU de Québec-Laval University Research Center

The research team analyzed the cases of 1870 children born between the 23rd week and the 32nd week of pregnancy and admitted to a neonatal intensive care unit in Quebec. Among them, 823 had serious complications, including 153 deaths. The main pathologies reported affected the lungs, nervous system, digestive system and eyes.

If the rates of complications among premature babies are maintained, nuanced Doctor Piedboeuf, “we can suppose that they are today less important for the less extremely premature babies than, for example, for those whom now called nanopremature – babies born after only 22 or 23 weeks of gestation.

The survival rate for premature babies born after 28 weeks of pregnancy is now 95%, due to the dazzling progress made in recent years. After this technical improvement, say the authors, it would seem that an improvement in the organization of work is necessary.

We realize that we must not only act on technology, but we must also act on the care team, the organization of care is also extremely important, underlined Doctor Piedboeuf.< /p>

Compensating for an insufficient number of nurses does not make it possible to compensate for all the other employees who are also called upon to intervene, from the attendants to the doctors through the pharmacists and the various therapists. […] It's the whole team as a whole that is important, he said.

Previous studies seemed to indicate that x27;An insufficient number of nurses on the floor compared to the recommended number was associated with a higher risk of nosocomial infections, intraventricular hemorrhage and mortality among very preterm infants.

The first author of this study published by the Archives of Disease in Childhood: Fetal & Neonatal is Dr. Marc Beltempo, from McGill University.

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