Document Detail


Mortality and morbidities among very premature infants admitted after hours in an Australian neonatal intensive care unit network.
MedLine Citation:
PMID:  16651317     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: 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. DESIGNS: 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. OUTCOMES: 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.
Authors:
Mohamed E Abdel-Latif; Barbara Bajuk; Julee Oei; Kei Lui;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  117     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-02     Completed Date:  2006-05-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1632-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia.
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MeSH Terms
Descriptor/Qualifier:
Apgar Score
Australian Capital Territory / epidemiology
Cesarean Section / utilization
Delivery, Obstetric / utilization
Fatigue
Female
Hospital Mortality*
Humans
Infant Mortality*
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal / manpower,  statistics & numerical data*
Male
New South Wales / epidemiology
Patient Admission*
Personnel Staffing and Scheduling
Risk Factors
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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