Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status.

Chung, Sung-Hoon; Kim, Chae Young; Choi, Yong Sung; Lee, Myung Hee; Lim, Jae Woo; Lee, Byong Sop; Kim, Ki-Soo

Chung, Sung-Hoon; Kim, Chae Young; Choi, Yong Sung; Lee, Myung Hee; Lim, Jae Woo; Lee, Byong Sop; Kim, Ki-Soo.

Afiliación

Chung SH; Department of Pediatrics, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Kim CY; Department of Pediatrics, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Choi YS; Department of Pediatrics, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Korea.
Lee MH; Center of Biomedical and Clinical Research, Meditos, Seoul, Korea.
Lim JW; Department of Pediatrics, College of Medicine, Konyang University, Daejon, Korea.
Lee BS; Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kim KS; Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Clin Exp Pediatr ; 2024 Sep 12.

Article en En | MEDLINE | ID: mdl-39265627

ABSTRACT

ABSTRACT

Background:

Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Understanding the impact of workload and regional differences on these rates is crucial for improving outcomes.

Purpose:

This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities.

Methods:

Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates.

Results:

This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with two rather than one neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates.

Conclusion:

Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

Palabras clave

Infant; Mortality; Neonatal intensive care units; Very low birth weight; Workload

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Exp Pediatr Año: 2024 Tipo del documento: Article Pais de publicación: