Mortality and Morbidity by Month of Birth of Neonates Admitted to an Academic Neonatal Intensive Care Unit

ArticleinPEDIATRICS 122(5):e1048-52 · November 2008with12 Reads
DOI: 10.1542/peds.2008-0412 · Source: PubMed
Abstract
Clinical expertise and skill of pediatric housestaff improve over the academic year, and performance varies despite supervision by faculty neonatologists. It is possible that variation in clinical expertise of housestaff affects important clinical outcomes in infants in ICUs. Our goal was to test the hypothesis that there is a decrease in morbidity and mortality in infants admitted to an NICU over the course of the academic year. A retrospective analysis was conducted using data on infants with birthweight 401 to 1500 g and >or=24 weeks' gestation (n = 3445) and infants with birth weights >1500 g (n = 7840) admitted to a regional NICU from January 1991 to June 2004. All infants were cared for by pediatric and neonatal housestaff supervised by neonatologists. Analysis of mortality and morbidity (intraventricular hemorrhage grades 3-4/periventricular leukomalacia, necrotizing enterocolitis >or= Bell stage 2, and bronchopulmonary dysplasia) over time were performed by repeated measures analysis of variance and the chi(2) test. Mortality rate in the 401 to 1500 g cohort, as well as the >1500 g cohort did not decrease over time during the academic year and was similar between the first (July-December) and second (January-June) halves of the academic year. There were no differences noted over the academic year for any of the morbidities. Morbidity and mortality in infants admitted to an academic NICU did not change significantly over the academic year. These observations suggest that the quality of care of critically ill neonates is not decreased early in the academic year.
    • "Nineteen studies comparing the start of the academic year to another time of year (Table S1a, Additional file 2) The first subcategory includes 19 studies investigating the impact of inexperienced residents on patient outcomes at the start of the academic year, also referred to as the July effect16171819202122232425262728293031323334. Of the 19 studies evaluating a July effect, 14 mostly surgical studies reported no differences in patient outcomes compared with other months of the year (risk-adjusted)1617181920222324252631323334. Of the five remaining studies, one study reported no difference in mortality in July, but potentially preventable complications did occur more often in July, although numbers were too small to allow for effective root cause analysis [27] . "
    [Show abstract] [Hide abstract] ABSTRACT: Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes. The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes. Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained. The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.
    Full-text · Article · Jun 2012
    • "Newborns admitted to neonatal intensive care units (NICU), and in particular preterm newborns are at high risk for morbidity and mortality during the first week of life because of respiratory distress and bronchopulmonary dysplasia, apnea and bradycardia, necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia , feeding difficulties, hypoglycemia, hyperbilirubinemia and neonatal sepsis [1] . Most of these neonatal morbidities , and in particular severe neonatal sepsis, which accounts for 11% -27% of NICU admissions234, are often associated with high mortality rates. "
    [Show abstract] [Hide abstract] ABSTRACT: The perfusion index, derived from the pulse oximeter signal, seems to be an accurate predictor for high illness severity in newborns. The aim of this study was to determine the perfusion index values of clinically and hemodynamically stable preterm newborns in the first week of life. Perfusion index recordings were performed on the first, third and seventh day of life on 30 preterm newborns. Their state of health was assessed according to clinical and behaviour evaluation and to the Score for Neonatal Acute Physiology. The median(interquartile range) perfusion index values were 0.9(0.6) on the first, 1.2(1.0) on the third, and 1.3(0.9) on the seventh day, with a significant increase between the first and the third day. Perfusion index proved to be an easily applicable, non-invasive method for monitoring early postnatal changes in peripheral perfusion. Its trend during the first week of life suggests that its clinical application should take age into account. Further studies are needed to obtain reference perfusion index values from a larger sample of preterm newborns, to identify specific gestational age-related cut-off values for illness and to test the role of perfusion index in monitoring critically ill neonates.
    Full-text · Article · Jan 2010
  • [Show abstract] [Hide abstract] ABSTRACT: The goal was to examine the impact of birth at night, on the weekend, and during July or August (the first months of the academic year) and the impact of resident duty-hour restrictions on mortality and morbidity rates for very low birth weight infants. Outcomes were analyzed for 11,137 infants with birth weights of 501 to 1250 g who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry in 2001-2005. Approximately one-half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessments at 18 to 22 months were completed for 4508 infants. Mortality rate, short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth. There was no effect of the timing of birth on mortality rate and no impact on the risks of short-term morbidities except that the risk of retinopathy of prematurity (stage > or =2) was higher after the introduction of duty-hour restrictions and the risk of retinopathy of prematurity requiring operative treatment was lower for infants born during the late night than during the day. There was no impact of the timing of birth on neurodevelopmental outcome except that the risk of hearing impairment or death was slightly lower among infants born in July or August. In this network, the timing of birth had little effect on the risks of death and morbidity for very low birth weight infants, which suggests that staffing patterns were adequate to provide consistent care.
    Full-text · Article · Aug 2010
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