Unit-Level Variations in Healthcare Professionals' Availability for Preterm Neonates <29 Weeks' Gestation: An International Survey

Maher Shahroor; Liisa Lehtonen; Shoo K Lee; Stellan Håkansson; Maximo Vento; Brian A Darlow; Mark Adams; Annalisa Mori; Kei Lui; Dirk Bassler; Naho Morisaki; Neena Modi; Akihiko Noguchi; Satoshi Kusuda; Marc Beltempo; Kjell Helenius; Tetsuya Isayama; Brian Reichman; Prakesh S Shah; on behalf of the International Network for Evaluation of Outcomes (iNeo) of neonates

doi:10.1159/000501801

Unit-Level Variations in Healthcare Professionals' Availability for Preterm Neonates <29 Weeks' Gestation: An International Survey

Neonatology. 2019;116(4):347-355. doi: 10.1159/000501801. Epub 2019 Oct 1.

Authors

Maher Shahroor¹, Liisa Lehtonen^{2

3}, Shoo K Lee^{1

4

5}, Stellan Håkansson⁶, Maximo Vento⁷, Brian A Darlow⁸, Mark Adams⁹, Annalisa Mori¹⁰, Kei Lui¹¹, Dirk Bassler¹², Naho Morisaki¹³, Neena Modi¹⁴, Akihiko Noguchi¹⁵, Satoshi Kusuda¹⁶, Marc Beltempo¹⁷, Kjell Helenius^{2

3}, Tetsuya Isayama¹⁸, Brian Reichman¹⁹, Prakesh S Shah^{20

21

22}; on behalf of the International Network for Evaluation of Outcomes (iNeo) of neonates

Affiliations

¹ Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
² Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
³ Department of Clinical Medicine, University of Turku, Turku, Finland.
⁴ Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁵ Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden.
⁷ Division of Neonatology and Health Research Institute La Fe, Valencia, Spain.
⁸ Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand.
⁹ Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹⁰ Neonatal Intensive Care Unit, University Hospital of Siena, Siena, Italy.
¹¹ National Perinatal Epidemiology and Statistic Unit, Royal Hospital for Women, University of New South Wales, Randwick, New South Wales, Australia.
¹² Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹³ Department of Social Medicine, Neonatal Research Network Japan, National Center for Child Health and Development, Tokyo, Japan.
¹⁴ UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom.
¹⁵ Illinois Neonatal Network, Chicago, Illinois, USA.
¹⁶ Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
¹⁷ Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada.
¹⁸ Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.
¹⁹ Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel.
²⁰ Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, pshah@mtsinai.on.ca.
²¹ Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada, pshah@mtsinai.on.ca.
²² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada, pshah@mtsinai.on.ca.

PMID: 31574502
DOI: 10.1159/000501801

Abstract

Introduction: The availability of and variability in healthcare professionals in neonatal units in different countries has not been well characterized. Our objective was to identify variations in the healthcare professionals for preterm neonates in 10 national or regional neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of neonates.

Method: Online, pre-piloted questionnaires about the availability of healthcare professionals were sent to the directors of 390 tertiary neonatal units in 10 international networks: Australia/New Zealand, Canada, Finland, Illinois, Israel, Japan, Spain, Sweden, Switzerland, and Tuscany.

Results: Overall, 325 of 390 units (83%) responded. About half of the units (48%; 156/325) cared for 11-30 neonates/day and had team-based (43%; 138/325) care models. Neonatologists were present 24 h a day in 59% of the units (191/325), junior doctors in 60% (194/325), and nurse practitioners in 36% (116/325). A nurse-to-patient ratio of 1:1 for infants who are unstable and require complex care was used in 52% of the units (170/325), whereas a ratio of 1:1 or 1:2 for neonates requiring multisystem support was available in 59% (192/325) of the units. Availability of a respiratory therapist (15%, 49/325), pharmacist (40%, 130/325), dietitian (34%, 112/325), social worker (81%, 263/325), lactation consultant (45%, 146/325), parent buddy (6%, 19/325), or parents' resource personnel (11%, 34/325) were widely variable between units.

Conclusions: We identified variability in the availability and organization of the healthcare professionals between and within countries for the care of extremely preterm neonates. Further research is needed to associate healthcare workers' availability and outcomes.

Keywords: Dietitian; Neonate; Neonatologist; Nurse; Pharmacist; Preterm infant; Respiratory therapist.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Gestational Age
Health Personnel / organization & administration*
Health Services Accessibility / organization & administration*
Humans
Infant, Extremely Premature*
Infant, Newborn
Intensive Care Units, Neonatal / organization & administration*
Internationality
Surveys and Questionnaires
Workforce / statistics & numerical data*