Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units - 11/01/13
, Marcelo L. Urquia, MSc PhD c, d, Howard Berger, MD b, Marian J. Vermeulen, BScN MHSc dContributors: Joel Ray, Howard Berger and Marian Vermeulen were responsible for the study concept. Marcelo Urquia was involved with the study design. Joel Ray, Marcelo Urquia and Marian Vermeulen were involved with the analysis and interpretation of the data. All of the authors contributed to the drafting and critical revision of the manuscript. Marian Vermeulen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All of the authors approved the final version of the manuscript submitted for publication.
Abstract |
Background |
Concurrent admission of a mother and her newborn to separate intensive care units (herein referred to as co-ICU admission), possibly in different centres, can magnify family discord and stress. We examined the prevalence and predictors of mother–infant separation and mortality associated with co-ICU admissions.
Methods |
We completed a population-based study of all 1 023 978 singleton live births in Ontario between Apr. 1, 2002, and Mar. 31, 2010. We included data for maternal–infant pairs that had co-ICU admission (n = 1216), maternal ICU admission only (n = 897), neonatal ICU (NICU) admission only (n = 123 236) or no ICU admission (n = 898 629). The primary outcome measure was mother–infant separation because of interfacility transfer.
Results |
The prevalence of co-ICU admissions was 1.2 per 1000 live births and was higher than maternal ICU admissions (0.9 per 1000). Maternal–newborn separation due to interfacility transfer was 30.8 (95% confidence interval [CI] 26.9–35.3) times more common in the co-ICU group than in the no-ICU group and exceeded the prevalence in the maternal ICU group and NICU group. Short-term infant mortality (< 28 days after birth) was higher in the co-ICU group (18.1 per 1000 live births; maternal age–adjusted hazard ratio [HR] 27.8, 95% CI 18.2–42.6) than in the NICU group (7.6 per 1000; age-adjusted HR 11.5, 95% CI 10.4–12.7), relative to 0.7 per 1000 in the no-ICU group. Short-term maternal mortality (< 42 days after delivery) was also higher in the co-ICU group (15.6 per 1000; age-adjusted HR 328.7, 95% CI 191.2–565.2) than in the maternal ICU group (6.7 per 1000; age-adjusted HR 140.0, 95% CI 59.5–329.2) or the NICU group (0.2 per 1000; age-adjusted HR 4.6, 95% CI 2.8–7.4).
Interpretation |
Mother–infant pairs in the co-ICU group had the highest prevalence of separation due to interfacility transfer and the highest mortality compared with those in the maternal ICU and NICU groups.
El texto completo de este artículo está disponible en PDF.Esquema
| Competing interests: None declared. This article has been peer reviewed. Funding: This study was funded by the Canadian Foundation for the Study of Infant Deaths. The foundation had no role in the study design, data collection or analysis, decision to publish or preparation of the manuscript. No honorarium, grant or other form of payment was received by the authors to produce this manuscript. Disclaimer: This study used data from the Institute for Clinical Evaluative Sciences (ICES). The institute is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions reported in this paper are those of the authors and are independent from these sources. No endorsement by ICES or the Ontario ministry is intended or should be inferred. |
Vol 184 - N° 18
P. E956-E962 - décembre 2012 Regresar al número
Artículo precedente
- Doctor gratitude: a framework and practical suggestions
- Stephen A. Buetow, Bruce Aroll
- Levels of 25-hydroxyvitamin D in familial longevity: the Leiden Longevity Study
- Raymond Noordam, Anton J.M. de Craen, Pardis Pedram, Andrea B. Maier, Simon P. Mooijaart, Johannes van Pelt, Edith J. Feskens, Martinette T. Streppel, P. Eline Slagboom, Rudi G.J. Westendorp, Marian Beekman, Diana van Heemst
¿Ya suscrito a @@106933@@ revista ?