Characteristics of neonatal units that care for very preterm infants in Europe: results from the MOSAIC study.
OBJECTIVE
We sought to compare guidelines for level III units in 10 European regions and analyze the characteristics of neonatal units that care for very preterm infants.


METHODS
The MOSAIC (Models of Organising Access to Intensive Care for Very Preterm Births) project combined a prospective cohort study on all births between 22 and 31 completed weeks of gestation in 10 European regions and a survey of neonatal unit characteristics. Units that admitted > or = 5 infants at < 32 weeks of gestation were included in the analysis (N = 111). Place of hospitalization of infants who were admitted to neonatal care was analyzed by using the cohort data (N = 4947). National or regional guidelines for level III units were reviewed.


RESULTS
Six of 9 guidelines for level III units included minimum size criteria, based on number of intensive care beds (6 guidelines), neonatal admissions (2), ventilated patients (1), obstetric intensive care beds (1), and deliveries (2). The characteristics of level III units varied, and many were small or unspecialized by recommended criteria: 36% had fewer than 50 very preterm annual admissions, 22% ventilated fewer than 50 infants annually, and 28% had fewer than 6 intensive care beds. Level II units were less specialized, but some provided mechanical ventilation (57%) or high-frequency ventilation (20%) or had neonatal surgery facilities (17%). Sixty-nine percent of level III and 36% of level I or II units had continuous medical coverage by a qualified pediatrician. Twenty-two percent of infants who were < 28 weeks of gestation were treated in units that admitted fewer than 50 very preterm infants annually (range: 2%-54% across the study regions).


CONCLUSIONS
No consensus exists in Europe about size or other criteria for NICUs. A better understanding of the characteristics associated with high-quality neonatal care is needed, given the high proportion of very preterm infants who are cared for in units that are considered small or less specialized by many recommendations.
Van Reempts
Patrick
P
Department of Neonatology, Antwerp University Hospital, University of Antwerp and Study Centre for Perinatal Epidemiology, Flanders, Belgium. patrick.van.reempts@uza.be
Gortner
Ludwig
L
Milligan
David
D
Cuttini
Marina
M
Petrou
Stavros
S
Agostino
Rocco
R
Field
David
D
den Ouden
Lya
L
Børch
Klaus
K
Mazela
Jan
J
Carrapato
Manuel
M
Zeitlin
Jennifer
J
D005060:Europe / Q000453:epidemiology; D005865:Gestational Age; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000145:classification / Q000458:organization & administration* / Q000706:statistics & numerical data*; D015997:Neonatal Screening / Q000379:methods; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
D011663:Pulmonary Surfactants