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Is quality of nursing care associated with infant outcomes in the neonatal intensive care unit (NICU)? To find out, researchers compared outcomes in very-low-birth-weight (VLBW) infants born in hospitals that did and did not meet criteria for recognition of nursing excellence (RNE). The study included 72,235 VLBW infants (501–1500 gm) born in 558 Vermont Oxford Network hospitals in 2007–2008. Twice as many RNE hospitals as non-RNE hospitals were teaching hospitals.
Overall 7-day mortality was 7.3%, 28-day mortality was 10.4%, and in-hospital mortality was 12.9%. Rates of severe intraventricular hemorrhage (SIVH) and nosocomial infection were 7.6% and 17.9%, respectively. In analyses adjusted for patient, NICU, and hospital characteristics, the odds for 7-day mortality (odds ratio, 0.87), nosocomial infection (OR, 0.86), and SIVH (OR, 0.88) were significantly lower in RNE hospitals than in non-RNE hospitals. All three mortality outcomes were significantly improved in infants ≥24 weeks' gestation at birth who were in RNE hospitals compared with non-RNE hospitals.
Lake ET et al. Association between hospital recognition for nursing excellence and outcomes of very low-birth-weight infants. JAMA 2012 Apr 25; 307:1709.
Barfield WD. Improving systems in perinatal care: Quality, not quantity. JAMA 2012 Apr 25; 307:1750.
Comment
As noted by an editorialist, examination of the association between quality of care and outcomes in very-low-birth-weight infants is overdue. The finding that high-quality neonatal nursing care is linked with better outcomes in very small infants is not surprising. Future research might reveal whether the designation of nursing excellence also reflects an institution-wide culture of greater standardization and safety.