Work environment, volume of activity and staffing in neonatal intensive care units in Italy: results of the SONAR-nurse study

Neonatal units' volume of activity, and other quantitative and qualitative variables, such as staffing, workload, work environment, care organization and geographical location, may influence the outcome of high risk newborns. Data about the distribution of these variables and their relationships among Italian neonatal units are lacking

Gestational age and hospital utilization: three-years follow-up of an area-based birth cohort

Objective: To investigate differences by gestational age in emergency department visits and re-hospitalizations during the three years following childbirth discharge. Methods: We performed a historical cohort study in Lazio Region, Italy, for infants born in 2007-2008 to resident mothers. Health administrative data were used. Analysis was performed by multinomial logistic regression. Results: Of 90,545 infants, more than 50% had at least one emergency department visit, and 18.8% at least one re-hospitalization. Relative risk ratios of both events increased by decreasing gestational age, and were higher for mothers ≤35 years of age, with low education and of Italian nationality. Residency outside the metropolitan area was associated with an increased risk of re-hospitalization and a decreased risk of emergency department visits. Conclusion: During the three years following childbirth discharge, re-hospitalizations and, to a lesser extent, emergency department use are inversely related to gestational age at birth; socio-demographic factors have an effect on the risk of infant use of hospital resources independent of gestational age.  

Late-preterm: un gruppo di neonati a rischio per disturbi dello sviluppo cognitivo Revisione sistematica della letteratura e descrizione degli strumenti di valutazione

Vengono definiti late-preterm (LP) o “pretermine tardivi” i bambini che nascono a 34-36 settimane di gestazione. I LP hanno un rischio aumentato, rispetto ai neonati a termine, di mortalità e morbosità in epoca neonatale e nelle età successive. Solo da pochi anni lo sviluppo cognitivo dei LP è stato oggetto di attenzione nella letteratura medica. Il presente studio è un’analisi sistematica dei lavori pubblicati in lingua ingle- se da gennaio 2006 a giugno 2013, aventi per oggetto lo sviluppo cognitivo e neuropsi- cologico dei LP dal primo anno di vita all’età scolare. Sono stati selezionati i lavori che utilizzavano scale di sviluppo e questionari standardizzati. Gli studi inclusi nella revi- sione sono 19, 11 dei quali in età prescolare e 8 in età scolare. I risultati indicano che in età prescolare i LP raggiungono un livello cognitivo mediamente più basso dei bam- bini nati a termine, in generale e in specifiche capacità cognitive. Anche in età scolare i LP hanno maggiori difficoltà nell’apprendimento rispetto ai bambini nati al termine della gravidanza. I motivi delle minori capacità dei LP possono essere legati alla pre- maturità in sé, ma anche alle cause che hanno provocato la nascita prima del termine

What we talk about when we talk about NICUs: infants’ acuity and nurse staffing

Objective: Organizational features of neonatal intensive care influence the care of sick neonates. We estimated the acuity-adjusted nurse-to-patient ratio (NPR) in a national sample of Italian NICUs and factors influencing it. Methods: Twelve monthly cross-sectional surveys were prospectively carried out in 63 NICUs. Number and acuity of infants, and number of nurses were recorded. Infants’ acuity was assessed by Rogowki’s 2013 and British Association for Perinatal Medicine 2001 classifications. Results: We collected 702 reports regarding 11 082 infants. Non-intensive infants represented about 75% of NICU residents. Very preterm infants (<1501 g birth weight or <30 weeks gestation) represented 10.8% of admissions, but 44% of all infants surveyed. Average acuity-adjusted NPR was 0.31 (interquartile range 0.28–0.38); NPR depended on case-mix (proportion of intensive infants), size of the unit (larger units had a lower NPR) and was higher during morning shifts (+18%). Clustering on hospitals, reflecting shared components within each hospital, explained 47% of the variability of NPR. Conclusions: The majority of infants cared for in NICUs are not intensive. NPR is influenced by acuity of infants, size of units, shifts, but is largely due to other unobserved hospital-related organizational features

Survey of neonatal respiratory support use in very preterm infants in Italy

Background: Respiratory support in very preterm infants is often a life-saving procedure and several techniques are available. There is lack of data on the current use of these techniques. Methods and aim: We analyzed a cohort of infants <30 weeks gestation or < 1501g birth weight, enrolled in the Italian Neonatal Network in 2009 and 2010 (n = 8297, mean gestation = 29.3 weeks, mean birth weight = 1089g) to ascertain the use of several techniques. We also conducted a questionnaire survey of all neonatal units adhering to the Italian Neonatal Network, inquiring about preferred methods of respiratory support. Results: Conventional ventilation was used in 53% of these infants, high frequency ventilation in 15.8%, CPAP in 71.6%, and surfactant in 56.2%. Huge variations were observed between hospitals for all techniques studied. The survey of centres showed that all respondents considered non-invasive ventilation the first-intention treatment for these infants. In case of need of tracheal intubation and mechanical ventilation, two hospitals said they used IPPV/IMV; 20 synchronized IPPV/IMV; 25 volume guarantee; and 10 hospitals used HFV as a first intention treatment (in five hospital for all infants, and in other five hospitals, depending upon birth weight/gestation. Conclusions: This study provides large scale, up to date results of the current methods of respiratory support in very preterm infants in Italy. Huge variations between hospitals, only partly explained by the paucity of evidence-based data, are apparent. These differences point to the possibility of implementing potentially better practices with the aim of reducing unwanted, physician-related variation. \ua9 2012 Informa UK, Ltd

Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian Neonatal Network

Variation of respiratory care is described between centers around the world. The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants