Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1632-1639 (doi:10.1542/peds.2005-1421)
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Mortality and Morbidities Among Very Premature Infants Admitted After Hours in an Australian Neonatal Intensive Care Unit Network

Mohamed E. Abdel-Latif, MBBS, MRCPCH, MPH, MscEpida,b, Barbara Bajuk, MPHc, Julee Oei, MBBS, FRACPa,b, Kei Lui, MBBS, FRACP, MDa,b for the New South Wales and the Australian Capital Territory Neonatal Intensive Care Audit Group

a Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia
b School of Women's and Children's Heath, University of New South Wales, New South Wales, Australia
c Neonatal Intensive Care Units Data Collection, New South Wales Centre for Perinatal Health Services Research, New South Wales, Australia

OBJECTIVES. To assess risk-adjusted early (within 7 days) mortality and major morbidities of newborn infants at <32 weeks' gestation who are admitted after office hours to a regional Australian network of NICUs where statewide caseload is coordinated and staffed by on-floor registrars working in shift rosters. We hypothesize that adverse sequelae are increased in these infants.

DESIGNS. We conducted a database review of the records of infants (n = 8654) at <32 weeks' gestation admitted to a network of 10 tertiary NICUs in New South Wales and the Australian Capital Territory from 1992 to 2002. Multivariate logistic regression analysis was performed to adjust for case-mix and significant baseline characteristics.

OUTCOMES. Sixty-five percent of infants were admitted to the NICUs after hours. These infants did not have an increase in early neonatal mortality or major neonatal sequelae compared with their office-hours counterparts. Admissions during late night hours after midnight or fatigue risk periods before the end of a medical 12-hour shift were not associated with higher early mortality. Risk factors significantly predictive of early neonatal death were lack of antenatal steroid treatment, Apgar score <7 at 5 minutes, male gender, gestation age, and being small for gestation.

CONCLUSIONS. Current staffing levels, specialization, and networking are associated with lower circadian variation in adverse outcomes and after-hours admission to this NICU network and have no significant impact on early neonatal mortality and morbidity.

Key Words: premature infant • outcome • office hours • mortality • perinatal services • staffing

Abbreviations: NSW—New South Wales • ACT—Australian Capital Territory • CRIB—clinical risk index for infants • OR—odds ratio • CI—confidence interval

Accepted Oct 18, 2005.




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