OBJECTIVE: Moderately preterm infants (30-34(6/7) weeks' gestational age) represent the largest population of NICU residents. Whether their clinical outcomes are associated with differences in NICU nurse-staffing arrangements has not been assessed. The objective of this study was to test the influence of patient-to-nurse ratios (PNRs) on outcomes of care provided to moderately preterm infants. PATIENTS AND METHODS: Using data from a prospective, multicenter, observational cohort study of 850 moderately preterm infants from 10 NICUs in California and Massachusetts, we tested for associations between PNR and several important clinical outcomes by using multivariate random-effects models. To correct for the influence of NICU size, we dichotomized the sample into those with an average daily census of <20 or > or =20 infants. RESULTS: Overall, we found few clinically significant associations between PNR and clinical outcomes of care. Mean PNRs were higher in large compared with small NICUs (2.7 vs 2.1; P < .001). In bivariate analyses, an increase in PNR was associated with a slightly higher daily weight gain (5 g/day), greater gestational age at discharge, any intraventricular hemorrhage, and severe retinopathy of prematurity. After controlling for case mix, NICU size, and site of care, an additional patient per nurse was associated with a decrease in daily weight gain by 24%. Other variables were no longer independently associated with PNR. CONCLUSIONS: In this population of moderately preterm infants, the PNR was associated with a decrease in daily weight gain, but was not associated with other measures of quality. In contrast with findings in the adult intensive care literature, measured clinical outcomes were similar across the range of nurse-staffing arrangements among participating NICUs. We conclude that the PNR is not useful for profiling hospitals' quality of care delivery to moderately preterm infants.
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机译：目的：中等早产儿（胎龄为30-34（6/7）周）是重症监护病房（NICU）居民的最大人口。他们的临床结局是否与重症监护病房（NICU）的工作人员安排的差异有关，尚未进行评估。这项研究的目的是测试患者对护士的比率（PNRs）对中度早产儿护理结果的影响。患者与方法：使用来自加利福尼亚州和马萨诸塞州10个重症监护病房的850名中度早产儿的前瞻性，多中心，观察性队列研究的数据，我们通过使用多元随机效应模型测试了PNR与一些重要临床结果之间的关联。为了校正NICU大小的影响，我们将样本分为平均每日普查<20或>或= 20婴儿的样本。结果：总体而言，我们发现PNR与护理的临床结果之间在临床上无显着关联。大的平均PNR比小的重症监护病房要高（2.7 vs 2.1; P <.001）。在双变量分析中，PNR的增加与每日体重增加（5 g /天）略高，出院时胎龄增加，任何脑室内出血以及严重的早产儿视网膜病变有关。在控制好病例组合，NICU大小和护理地点后，每名护士增加一名患者可使每日体重增加减少24％。其他变量不再与PNR独立相关。结论：在这个中度早产儿人群中，PNR与每日体重增加减少有关，但与其他质量指标无关。与成人重症监护文献中的发现相反，参与的重症监护病房之间在各种护士工作人员安排中，所测得的临床结局相似。我们得出的结论是，PNR不能用于描述医院对中早产儿的护理质量。
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