Better Nurses Produce Healthier Preemies

VLBW infants in top nurse-rated hospitals benefit

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Every pregnant mom wants to receive quality care from doctors and nurses. According to a new study, delivering your baby at a hospital that’s recognized for nursing excellence can impact your baby’s health.

Researchers from the University of Pennsylvania School of Nursing studied more than 72,000 very low-birth-weight (VLBW) infants (less than 3.3 pounds at birth).  

They found that that babies born at hospitals recognized for nursing excellence (RNE) were less likely to suffer certain complications, compared to babies at hospitals that haven’t been recognized for nursing excellence.

The babies at RNE hospitals were at lower risk for infection, death at seven days and severe intraventricular hemorrhage (SIVH), which happens when bleeding occurs into the ventricles of the brain.

However, there was no significant difference in the rate of death at 28 days or hospital stay mortality, the researchers report.

"Women at risk of premature birth should find a hospital with RNE."

One in four very low-birth-weight infants dies in the first year of life, according to the study’s authors, with 87 percent occurring in the first month. Since VLBW babies require intensive nursing care, the study sought to examine whether the quality of nursing impacted these babies’ outcomes.

Eileen T. Lake, Ph.D., R.N., of the University of Pennsylvania School of Nursing, and her colleagues looked at 72,235 babies weighing 3.3 pounds and under (the lowest weight was 501 grams) born in 558 neonatal intensive care units in the Vermont Oxford Network between January 2007 and December 2008.

The researchers cross-referenced each hospital’s RNE, which was obtained from the American Nurses Credentialing Center. The authors noted that only 7 percent of U.S. hospitals are recognized for nursing excellence.

The study looked at several outcomes: seven-day mortality; 28-day mortality; hospital stay mortality; hospital infection (infection in the blood or cerebrospinal fluid occurring three days post-birth); and SIVH.

Overall, the research team found that 7.3 percent of all infants suffered seven-day mortality; 10.4 percent, 28-day mortality; 12.9 percent, hospital stay mortality; 17.9 percent, hospital infection; and 7.6 percent, SIVH.

However, babies born at RNE hospitals had fewer complications in certain areas, the authors report. The seven-day mortality rate was 7 percent at RNE hospitals and 7.4 percent at non-RNE hospitals; 28-day mortality was 10.4 percent at RNE hospitals, compared to 10.5 percent at non-RNE; hospital stay mortality was 12.4 percent in RNE hospitals, compared to 13.1 percent in non-RNE hospitals; SIVH was 7.2 percent in RNE hospitals, compared to 7.8 percent in non-RNE hospitals; hospital infection occurred in 16.7 percent of babies in RNE hospitals, compared to 18.3% in non-RNE hospitals.

The authors conclude that babies born in RNE hospitals may have the advantage of access to high-quality neonatal intensive care unit (NICU) and obstretric care. It may not be directly linked to RNE but instead be due to other aspects of high-quality care, such as excellent physician care, respiratory care or infection control, they say.

These findings are especially important for mothers at high risk of preterm birth (less than 37 weeks), the authors note. Only 1 in 5 hospitals with a NICU has RNE, which impacts minority mothers and babies, as few minority babies are born in hospitals with RNE, they say.

This study was published in the April issue of JAMA and funded by grants from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative and National Institute of Nursing Research, National Institutes of Health.

Reviewed by: 
Review Date: 
April 27, 2012
Last Updated:
May 9, 2012