Nursing excellence associated with better outcomes for preemies

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Nursing Excellence Ups Very Low Birth Weight Baby Outcomes
Nursing Excellence Ups Very Low Birth Weight Baby Outcomes

HealthDay News -- Hospitals recognized for nursing excellence (RNE) fare better when it comes to caring for very low birth weight (VLBW) infants, data suggest.

High quality nursing significantly lowers hospital infection rates, seven-day mortality, and severe intraventricular hemorrhage in this high risk infant group, Eileen T. Lake, PhD, RN, from the University of Pennsylvania School of Nursing in Philadelphia, and colleagues reported in the Journal of the American Medical Association.

However, when it came to 28-day mortality or hospital stay mortality, VLBW infant outcomes were not significantly different, the researchers found.

They studied a cohort of 73,235 VLBW infants (weighing between 501 to 1,500 grams) cared for in the Vermont Oxford Network hospital neonatal intensive care units from 2007 to 2008. The researchers identified hospitals recognized for nursing excellence based on data from the American Nurses Credentialing Center.

The researchers found that outcome rates were better, though not always significantly, at RNE hospitals compared with non-RNE hospitals:

  • Seven-day mortality -- 7% vs. 7.4% (adjusted odds ratio [aOR], 0.87; P = 0.04);
  • 28-day mortality -- 10% vs. 10.5% (aOR, 0.90; P = 0.08);
  • Hospital-stay mortality -- 12.4% vs. 13.1% (aOR, 0.90; P = 0.06);
  • Severe intraventricular hemorrhage -- 7.2% vs. 7.8% (aOR, 0.88; P = 0.045); 
  • Infection -- 16.7% vs. 18.3% (aOR, 0.86; P = 0.04).

The combined decrease in all five outcomes was significant, with the mean effect across all five outcomes having an OR of 0.88.

Recognition for nursing excellence may serve as a marker for high quality health care, the researchers suggested.

"Perhaps RNE hospitals have a broad, long-standing commitment to quality care that is reflected in other aspects of care, such as excellent physician care, respiratory care, or infection control, that are not directly related to RNE but that may independently contribute to better outcomes for VLBW infants," they wrote.

In an accompanying editorial, Wanda D. Barfield, MD, MPH, of the CDC's Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion called for further research to determine  which characteristics of RNE status are specifically associated with the improved outcomes.

"[U]ntil a way is found to prevent prematurity and low birth weight, a better understanding is needed of how best to strengthen the components of care that contribute to the survival of VLBW infants," Barfield wrote.

Lake ET. JAMA. 2012;307(16):1709-1716.

Barfield WD. JAMA. 2012;307(16):1750-1751.

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