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Study: Nursing care for VLBW infants needs improvement

Monday March 18, 2013
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Infants of very low birth weight do not receive optimal nursing care, according to a study, potentially leading to hospital-acquired infections that double their death rate or result in long-term developmental issues.

VLBW infants, those weighing less than 3.25 pounds, are the highest-risk pediatric patients in hospitals and account for half of all infant deaths in the country each year, according to background information in the study, which was published March 18 on the website of JAMA Pediatrics (formerly the Archives of Pediatrics & Adolescent Medicine). These hospital-acquired infections affected 13.9% of VLBW infants in 2009, the last year reported in the study.

Researchers studied VLBW infants cared for in 67 NICUs. "One-third of NICU infants were understaffed, according to current guidelines," wrote principal investigators Jeannette A. Rogowski, PhD, economics professor at the University of Medicine and Dentistry of New Jersey, and Eileen T. Lake, RN, PhD, FAAN, associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

Hospitals understaffed 32% of their NICU infants and 92% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require increasing staff by 0.11 nurses per infant overall and 0.39 nurses per high-acuity infant, the researchers wrote. The bigger the staffing shortfall relative to national guidelines in the NICUs studied, the greater the odds of infection, although the study did not prove a cause-and-effect relationship.

The researchers noted that infection increased hospital stay by four to seven days, with associated increased costs, notably to Medicaid. "Under recent changes in Medicaid policy, hospitals will no longer be reimbursed for the costs associated with these infections," Lake said, according to a news release. "Sadly, because Medicaid is the largest payer for premature newborns, the additional costs may lead hospitals to further cut the nursing staff, leading to a cycle of infection and mortality that could impact even more of these fragile infants."

"These are the first data that demonstrate the extent of adherence to national staffing guidelines, and the shortfall is dramatic," Rogowski said. "Fewer nursing hours could lead to less time devoted to cleaning and maintaining intravenous catheters used to deliver medications, thus leading to the higher rates of infection."

The researchers examined data from 67 NICUs involving 4,046 nurses and 10,394 infants in 2008 and 3,645 nurses and 8,804 infants in 2009-10. The research was funded by the National Institute for Nursing Research and the Robert Wood Johnson Foundation.

The study abstract is available at http://archpedi.jamanetwork.com/article.aspx?articleid=1669323.


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