The provision of neonatal services: Data for international comparisons

Abstract

This product is part of the RAND Corporation technical report series. Reports may include research findings on a specific topic that is limited in scope; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity. The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.R ® is a registered trademark. © Copyright 2008 RAND CorporationAll rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from RAND. The research described in this report was prepared for the National Audit Office.i DedicationThis report is dedicated to the memory of Alice Farrands.iii PrefaceThe National Audit Office (NAO) is undertaking a Value for Money study of neonatal services in England. As part of this study, RAND Europe was commissioned to gather information on neonatal services in countries other than England. This information will supplement the evidence the NAO gathers on England and will allow for international comparisons and benchmarking.As requested by the NAO, the report presents data gathered from a thorough search of the literature on the status and provision of neonatal services in the UK nations of Scotland, Wales, Northern Ireland and the United States of America, Canada, Sweden, and Australia. The report also compares relevant neonatal statistics for England against those for the nations named above, although England is not the report's main focus.The report presents a comparative analysis of neonatal services, followed by chapters on specific countries. The information is presented along five dimensions defined by the NAO: 1) trends in high-risk births and associated outcomes, including mortality and comorbidities; 2) organisation and scale of neonatal services; 3) neonatal transport services; 4) costs of neonatal services and 5) best practices for infants and their families.RAND Europe is an independent not-for-profit policy-research organisation whose mission is to help improve policy and decision-making through research and analysis. This report has been peer reviewed in accordance with RAND's quality assurance standards.

Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units

“…Neonatal intensive care is a specialty where both nurse shortages and patient safety issues are particularly serious (Harrigan & Perez 2003, Hallsworth et al. 2008).…”

“…2008). Indeed, in many countries gaps between supply and demand for Registered Nurses are especially problematic in neonatal intensive care units (NICUs) (Harrigan & Perez 2003, Hallsworth et al. 2008).…”

Morte neonatal precoce segundo complexidade hospitalar e rede SUS e não-SUS na Região Metropolitana de São Paulo, Brasil

“…htm#mort, acessado em 28/Jul/2009) indicam que, em 2005, a taxa de mortalidade infantil correspondia a 21,2 óbitos por mil nascidos vivos, com a neonatal respondendo por cerca de 2/3 das mortes infantis (14,1 por mil). A taxa de mortalidade neonatal da Região Metropolitana de São Paulo (6,0 por mil nascidos vivos) pode ser considerada elevada, quando comparada àque-las de países desenvolvidos, como Inglaterra e Canadá, que não ultrapassam a 4 por mil nascidos vivos 2 . Na Região Metropolitana de São Paulo, o componente precoce responde por 70% da mortalidade neonatal e 45% da infantil.…”

Racionalidad a diario: neumonía

“…Un reciente artículo estima que la tasa de consultas ambulatorias pediátricas por neumonía adquirida en la comunidad no se modificó significativamente entre 1994 (19,2/1000) y 2007 (22,4/1000). 2 Pero más interesante aún es la investigación que hacen los autores sobre el uso de antibióti-cos en estos pacientes, encontrando que en cerca del 80% de los que recibían antibióticos se trataba de un antibiótico de espectro inadecuado (macrólidos o cefalosporinas) o de amplio espectro (amoxicilina-clavulanato), en lugar de penicilina (o amoxicilina). Además, ellos encontraron que este fenómeno se asociaba al incremento en la edad de los pacientes y a la atención en consultorio en relación a los asistidos en hospitales.…”

“…En algunos servicios de maternidad, enfermeras especialmente capacitadas en los cuidados neonatales ocupan el lugar de los médicos neonatólogos faltantes. 2 Pero también se menciona que el núme-ro de profesionales de enfermería no es suficiente, realidad que afecta a todos los países.…”