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Fall in neonatal nurses linked to higher death rate

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A fall in the provision of one-to-one nursing care of very sick and premature newborns is linked to a higher death rate in neonatal intensive care, according to a UK study.

The British Association of Perinatal Medicine recommends one-to-one nursing care for newborns in neonatal intensive care in the UK, and a ratio of one nurse for every two in high dependency units.

“This research adds to a significant body of evidence that shows the importance of proper neonatal nurse staffing levels for babies’ survival”

Caroline Davey

The researchers assessed the impact of one-to-one nursing on the monthly death rate in tertiary level neonatal units – those designated to provide intensive care – in England.

They extracted monthly data supplied to the National Neonatal Research Database on infants admitted to 43 tertiary level care units from 2008-12.

Using these figures, they calculated the proportion of neonatal intensive care days or intensive care admissions for which one-to-one nursing care was provided during this timeframe.

Between 2008 and 2012, the proportion of one to one nursing care provided in tertiary level neonatal units fell by a third, from an average of 9% to an average of around 6%.

Similarly, the proportion of infants admitted who received one-to-one nursing care fell from around 39.5% to just under 36%.

During the period, an average of 4.5% of infants receiving intensive care died every month.

The researchers calculated that a 10 percentage point fall in the proportion of intensive care days on which one-to-one nursing care was provided was associated with a monthly increase in the inpatient death rate of 0.6% in intensive care.

“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 labour provision on neonatal units in England,” the researchers said in the Archives of Disease in Childhood (Fetal & Neonatal Edition).

Caroline Davey, chief executive of the premature and sick baby charity Bliss, said: “This research adds to a significant body of evidence that shows the importance of proper neonatal nurse staffing levels for babies’ survival, but also the distance we have yet to go to ensure that the sickest and most vulnerable babies receive the care that they deserve.

“The government and NHS must now take action to improve staffing levels within neonatal care, in order to ensure that babies are receiving the very best care,” she added.

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