Hamilton Karen E St C, Redshaw Margaret E, Tarnow-Mordi William
National Perinatal Epidemiology Unit, University of Oxford, UK.
Arch Dis Child Fetal Neonatal Ed. 2007 Mar;92(2):F99-F103. doi: 10.1136/adc.2006.102988. Epub 2006 Nov 6.
To assess whether risk-adjusted mortality in very low birthweight or preterm infants is associated with levels of nursing provision.
Prospective study of risk-adjusted mortality in infants admitted to a random sample of neonatal units.
Fifty four UK neonatal intensive care units stratified by: patient volume; consultant availability; nurse:cot ratios.
A group of 2585 very low birthweight (birthweight <1500 g) or preterm (<31 weeks gestation) infants.
Death before discharge or planned deaths at home, excluding lethal malformations, after adjusting for initial risk 12 hours after birth using gestation at birth and measures of illness severity in relation to nursing provision calculated for each baby's neonatal unit stay.
A total of 57% of nursing shifts were understaffed, with greater shortages at weekends. Risk-adjusted mortality was inversely related to the provision of nurses with specialist neonatal qualifications (OR 0.67; 95% CI 0.42 to 0.97). Increasing the ratio of nurses with neonatal qualifications to intensive care and high dependency infants to 1:1 was associated with a decrease in risk-adjusted mortality of 48% (OR: 0.52, 95% CI: 0.33, 0.83).
Risk-adjusted mortality did not differ across neonatal units. However, survival in neonatal care for very low birthweight or preterm infants was related to proportion of nurses with neonatal qualifications per shift. The findings could be used to support specific standards of specialist nursing provision in neonatal and other areas of intensive and high dependency care.
评估极低出生体重或早产婴儿的风险调整死亡率是否与护理人员配备水平相关。
对随机抽取的新生儿病房收治的婴儿进行风险调整死亡率的前瞻性研究。
英国54家新生儿重症监护病房，按以下因素分层：患者数量；顾问可及性；护士与婴儿床比例。
一组2585名极低出生体重（出生体重<1500克）或早产（妊娠<31周）的婴儿。
出院前死亡或计划在家中死亡，不包括致命畸形，在根据出生时的孕周和每个婴儿在新生儿病房住院期间与护理相关的疾病严重程度指标对出生后12小时的初始风险进行调整后。
共有57%的护理班次人员不足，周末短缺情况更严重。风险调整死亡率与具备新生儿专科资质的护士配备呈负相关（比值比0.67；95%置信区间0.42至0.97）。将具备新生儿资质的护士与重症监护和高危婴儿的比例提高到1:1，可使风险调整死亡率降低48%（比值比：0.52，95%置信区间：0.33，0.83）。
各新生儿病房的风险调整死亡率无差异。然而，极低出生体重或早产婴儿在新生儿护理中的存活率与每班具备新生儿资质的护士比例有关。这些发现可用于支持新生儿及其他重症和高危护理领域专科护理的具体标准。
