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Care advances aid neonatal survival

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Advancements in nursing care, including leadership and communication skills, have contributed to significant improvements in neonatal survival rates over the last 20 years, suggests UK research.

Between January 1981 and December 2000, researchers studied all infants born alive at 22–25 weeks’ gestation and admitted to the neonatal unit at University College London Hospitals NHS Foundation Trust.

They found the infant survival rate more than doubled during this period, increasing from 32% in 1981 to 71% in 2000.
Of the 357 infants studied, 45% survived to discharge from the unit, and three-quarters of the 161 infants who underwent medical assessment at one year showed no signs of impairment leading to disability.

The authors said major advances in neonatal care over the last two decades – including improvements in respiratory support, nutrition and nursing care – all contributed to the survival of infants who previously would have died.

Adopting a uniform approach to decision-making can also significantly improve outcomes, they added. Lead study author John Wyatt, consultant at UCL’s Institute for Women’s Health, said: ‘[This study] provides information on the survival rates that can be achieved with consistent levels of staffing and resources, and with consistent policies.’

Dee Beresford, executive officer of the Neonatal Nurses Association, said: ‘The study results are very encouraging. But, as it was a single-cohort study, I would like to see it repeated elsewhere to see if the results could be replicated.

‘What it does reflect are the significant advances in nursing leadership over the years, and the increased communication between nursing and medical teams,’ she said.

‘Neonatal care is not a black and white area, and there are ethical dilemmas involved when dealing with the lives of very small babies,’ Ms Beresford added. ‘Consistent policies and practices that people can agree on, and have ownership of, need to be adopted by everybody.’

Acta Paediatrica (2008) 97: 159–165

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