Mortality and morbidities among very premature infants admitted after hours in an Australian neonatal intensive care unit network.
OBJECTIVE
To assess risk-adjusted early (within 7 days) mortality and major morbidities of newborn infants at < 32 weeks' gestation who are admitted after office hours to a regional Australian network of NICUs where statewide caseload is coordinated and staffed by on-floor registrars working in shift rosters. We hypothesize that adverse sequelae are increased in these infants.


METHODS
We conducted a database review of the records of infants (n = 8654) at < 32 weeks' gestation admitted to a network of 10 tertiary NICUs in New South Wales and the Australian Capital Territory from 1992 to 2002. Multivariate logistic regression analysis was performed to adjust for case-mix and significant baseline characteristics.


RESULTS
Sixty-five percent of infants were admitted to the NICUs after hours. These infants did not have an increase in early neonatal mortality or major neonatal sequelae compared with their office-hours counterparts. Admissions during late night hours after midnight or fatigue risk periods before the end of a medical 12-hour shift were not associated with higher early mortality. Risk factors significantly predictive of early neonatal death were lack of antenatal steroid treatment, Apgar score < 7 at 5 minutes, male gender, gestation age, and being small for gestation.


CONCLUSIONS
Current staffing levels, specialization, and networking are associated with lower circadian variation in adverse outcomes and after-hours admission to this NICU network and have no significant impact on early neonatal mortality and morbidity.
Abdel-Latif
Mohamed E
ME
Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia.
Bajuk
Barbara
B
Oei
Julee
J
Lui
Kei
K
D001034:Apgar Score; D020958:Australian Capital Territory / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005221:Fatigue; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010343:Patient Admission; D010561:Personnel Staffing and Scheduling; D012307:Risk Factors; D013997:Time Factors; D000078329:Workforce