More newborns die in ICU without 1-to-1 nursing

Between 2008 and 2012 the proportion of one-to-one nursing care provided fell by a third in the UK, from an average of 9 percent to 6 percent. (Credit: iStockphoto)

A decline in one-to-one nursing care of very sick and premature newborns is linked to a higher death rate in neonatal intensive care units in the UK, a new study shows.

The British Association of Perinatal Medicine (BAPM) recommends one-to-one nursing care for newborns in neonatal intensive care in the UK, and a ratio of one nurse for every two infants in high dependency units. For infants in receipt of special care, the recommended ratio is 1:4.

Yet few neonatal units have achieved the required staffing ratios.

“We believe the results in this study provide some evidence in support of a one-to-one, nurse-to-patient ratio in neonatal intensive care in England, in line with BAPM guidelines, and therefore provide increased nursing labor provision on neonatal units in England,” says Sam Watson of the University’s Warwick Medical School, who is lead author of the study published in the Archives of Disease in Childhood.

Watson and colleagues analyzed monthly data supplied to the National Neonatal Research Database (NNRD) on infants admitted to 43 tertiary-level care units between 2008 and 2012.

[Hospital care varies for tiniest preterm babies]

They calculated the proportion of neonatal intensive care days or intensive care admissions for which one-to-one nursing care was provided.

Between 2008 and 2012, the proportion of one-to-one nursing care provided fell by a third, from an average of 9 percent to 6 percent. Similarly, the proportion of infants admitted who received one-to-one nursing care fell from around 39.5 percent to just under 36 percent.

During this period, an average of 4.5 infants out of every 100 (4.5 percent) in receipt of intensive care died every month.

They calculated that a 10 percentage point fall in the proportion of intensive care days on which one-to-one nursing care was provided was linked to a monthly increase in the inpatient death rate of 6 per 1000 infants (0.6 percent) in intensive care.

“While these findings from an observational study support an increase in one-to-one nursing provision in tertiary-level neonatal units, they do not inform us whether a one-to-one nurse to patient ratio for all intensive care days would have a beneficial effect,” says Watson.

Source: University of Warwick