Choosing the right hospital may make the difference between life and death for very low birth weight infants, according to research led by the University of Pennsylvania School of Nursing and just released in JAMA The Journal of the American Medical Association.
In a comprehensive study of 72,235 infants born in 558 hospitals across the nation, the researchers found that babies cared for in hospitals with the Magnet credential were less likely to die, acquire a hospital-based infection, or suffer severe brain hemorrhage. While only 1.5 percent of births nationally are very low birth weight babies, weighing between 1 and 3.3 pounds, they account for more than half of all infant deaths. Nearly 16,000 VLBW infants died in 2007, most within the first month of life.
"Babies born in Magnet hospitals had 13 percent lower odds of death within the first week of life, 14 percent lower odds of infection, and 12 percent lower odds of hemorrhage," said lead author and nursing professor Eileen Lake, PhD, RN. "Surviving hemorrhage may have serious lifelong consequences for these infants, and can result in cerebral palsy, lower IQ, and developmental delays." Babies born in for-profit hospitals showed higher rates of infection, the researchers found, which doubles the infants' chances of dying; brain hemorrhage results in a six times greater risk of death.
The Magnet designation is given to hospitals after an extensive review by the American Nurses Credentialing Center for "quality patient care, nursing excellence, and innovations in professional nursing practice," the researchers wrote, noting that these tiniest of infants require nurses to make "complex assessments, implement highly intensive therapies, and make immediate adjustments dependent on infant response."
While only seven percent of US hospitals have the Magnet designation, one in five hospitals (20 percent) with a NICU have been awarded the credential. However, the study noted that twice as many white infants as black infants were born in Magnet hospitals.
"In absolute terms, the outcomes are 1 to 2 percentage points lower in Magnet hospitals, which translates to 300 infants each year who could be spared each of these severe consequences," said Dr. Lake. "Access to Magnet hospitals can literally make a life or death difference." The Magnet designation which refers to a hospital's ability to attract and retain nurses, can usually be found on a hospital's website or on the ANCC website.
The researchers studied premature infants weighing from 500 to 1500 grams at birth with the average being 1036 (2.2 pounds). Forty-seven percent were white; 29 percent were black, and 24 percent Hispanic, Asian or American Indian and were born in 2007 and 2008.
The team of researchers conducted phases of the research under the auspices of a $2.1 million grant from the National Institute of Nursing Research, one of the National Institutes of Health, and $300,000 from The Robert Wood Johnson Foundation.
- E. T. Lake, D. Staiger, J. Horbar, R. Cheung, M. J. Kenny, T. Patrick, J. A. Rogowski. Association Between Hospital Recognition for Nursing Excellence and Outcomes of Very Low-Birth-Weight Infants. JAMA: The Journal of the American Medical Association, 2012; 307 (16): 1709 DOI: 10.1001/jama.2012.504
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