Chung Sung-Hoon, Kim Chae Young, Choi Yong-Sung, Lee Myung Hee, Lim Jae Woo, Lee Byong Sop, Kim Ki-Soo
Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.
Clin Exp Pediatr. 2024 Nov;67(11):619-627. doi: 10.3345/cep.2023.01613. Epub 2024 Sep 12.
Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Under-standing the impact of workload and regional differences on these rates is crucial for improving outcomes.
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.
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.
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 2 rather than 1 neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates.
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.
极低出生体重儿（VLBWIs）受新生儿重症监护病房（NICUs）护理质量影响，仍面临较高死亡风险。了解工作量和地区差异对这些死亡率的影响对于改善结局至关重要。
本研究旨在评估新生儿重症监护病房的结构和人员配备属性如何影响极低出生体重儿的死亡率，强调医务人员可用性和护理设施地区分布的重要性。
回顾性分析韩国新生儿网络在2015年1月至2016年12月期间收集的69家韩国新生儿重症监护病房的数据。这些新生儿重症监护病房按各种参数分类：容量（小、中、大）、护士与床位比（1-4）以及地区位置（A、B、C）。还分析了儿科医生的人员配备情况，并将新生儿重症监护病房按每名儿科医生的床位数分为低（≤10）、中（11-15）和高（≥16）三类。根据死亡率将新生儿重症监护病房分为高性能（第1和第2四分位数）和低性能（第3和第4四分位数）。使用多因素逻辑回归分析人口统计学、围产期和新生儿结局，以探讨新生儿重症监护病房特征与死亡率之间的关联。
本研究纳入了4745例极低出生体重儿（平均胎龄28.4周；平均出生体重1088克；55.4%为男性），发现不同新生儿重症监护病房的存活率因绩效和人员配备水平存在显著差异。高性能的新生儿重症监护病房通常床位与工作人员比例较低且护理水平较高，存活率也较高。值得注意的是，配备2名而非1名新生儿科医生的新生儿重症监护病房死亡率较低。该研究还强调了地区差异，某些地区的新生儿重症监护病房存活率较低。
充足的新生儿重症监护病房人员配备和合理的设施位置是降低极低出生体重儿死亡人数的关键。加强人员配备和地区医疗公平性对于提高这一人群的存活率至关重要。
