399 - Association of Neonatal Intensive Care Unit Resources with Outcomes Among Very Preterm Infants

Poster Number: 399
Publication Number: 399.436

Safiya Soullane, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Prakesh Shah, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Abhay K. Lodha, University of Calgary, Calgary, AB, Canada; Sandesh Shivananda, Ubc, Vancouver, BC, Canada; Stephanie Redpath, Children's Healthcare of Eastern Ontario, Ottawa, ON, Canada; Mary Seshia, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Charles David A. Simpson, Dalhousie University Faculty of Medicine, Halifax, NS, Canada; Petros Pechlivanoglou, The Hospital for Sick Children, Toronto, ON, Canada; Bruno Piedboeuf, Universite Laval, Quebec, PQ, Canada; Xiang Y. Ye, MiCare research Center, Mount Sinai Hospital, Toronto, ON, Canada, Toronto, ON, Canada; Marc Beltempo, McGill University, Montreal, PQ, Canada

Background: Human resource allocation in the neonatal intensive care unit (NICU) may influence outcomes of preterm infants.

Objective: To evaluate the association between the number of physicians, medical support staff, pharmacists and nutritionists in the NICU and mortality/major morbidity among infant born < 33 weeks.

Design/Methods: Cross-sectional cohort study of 7,653 infants born 23-32 weeks gestation, admitted from 2014-2015 to Level 3 NICUs that participated in a survey on resource allocation. Exposures were number of physicians (neonatologists or pediatricians), medical support staff (clinical assistants, neonatology trainees or nurse practitioners), pharmacists and nutritionists, defined as the ratio of provider full-time equivalents (FTE) per 10 occupied beds averaged per year. Primary outcome was mortality and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). We used multivariable logistic regression to calculate the adjusted odds ratios (AOR) and 95% confidence interval (CI) for the association between staffing ratios and mortality/major morbidity.

Results: Among the 30 participating NICUs, median unit size was 31 beds [IQR 22-45] (Table 1). The 4 main exposure variables did not correlate with each other (Pearson correlation coefficients < 0.47). There was a U-shaped association between unit size and number of physicians, but no correlation between unit size and other provider staffing ratios (Figure 1). Rates of mortality and mortality/major morbidity were 5% (412/7653) and 30% (2267/7653) respectively. Higher number of physicians was not associated with mortality/major morbidity (AOR 1.04, 95% CI 0.92-1.17), but was associated with lower odds of mortality (AOR 0.80, 95% CI 0.65-0.98, Table 2). Higher number of medical support staff was associated with higher odds mortality/morbidity (AOR 1.12, 95% CI 1.01-1.24). Higher numbers of pharmacists and nutritionists were associated with lower odds of mortality/morbidity. Sub-group analyses among infants born < 29 weeks showed similar results.Conclusion(s): Higher number of physicians was associated with lower odds of mortality in the NICU. Higher number of medical support staff was associated with higher odds of mortality/morbidity, while higher number of nutritionists and pharmacists was associated with lower adjusted odds of mortality/morbidity. The data suggests that human resource allocation and team composition may influence health outcomes in the NICU. Future prospective cohort analyses are needed to validate the results of this survey-linked study.
Curriculum vitaeCurriculum Vitae_Soullane PAS.pdf
Figure 1. Association of full-time equivalent physicians per 10 occupied beds with total number of beds in NICU.