Introduction of 24 h Resident Consultant Cover in a Tertiary Neonatal Unit—Impact on Mortality and Clinical Outcomes

• Published in: Children (Basel) 2021-09, Vol.8 (10), p.865
• Main Authors: Zorro, Carolina, Dassios, Theodore, Hickey, Ann, Arasu, Anusha, Bhat, Ravindra, Greenough, Anne
• Format: Article
• Language: English
• Subjects: Apgar score; Birth weight; Consultants; COVID-19; Gestational age; Hospitals; Hypothermia; Intensive care; Mortality; neonatal outcomes; Newborn babies; Pediatrics; Regression analysis; resident consultants; Statistical analysis; Ventilators; Working hours
• ISSN: 2227-9067; 2227-9067
• DOI: 10.3390/children8100865

Background: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Methods: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010–2020 of all liveborn infants admitted to the neonatal unit. Out of hours cover was rearranged in 2014 to ensure 24 h presence of a senior trained neonatologist (resident consultant). Results: In the study period, 4778 infants were included: 2613 in the pre-resident period and 2165 in the resident period. The median (IQR) time to first consultation by a senior member of staff was significantly longer in the pre-resident period [1.5 (0.6–4.3) h] compared to the resident period [0.5 (0.3–1.5) h, p < 0.001]. Overall, mortality was similar in the pre-resident and the resident periods (3.2% versus 2.3%, p = 0.077), but the mortality of infants born at night was significantly higher in the pre-resident (4.5%) compared to the resident period (2.5%, p = 0.016). The resident period was independently associated with an increased survival to discharge (adjusted p < 0.001, odds ratio: 2.0) after adjusting for gestational age, admission temperature and duration of ventilation. Conclusions: Following introduction of a resident consultant model the mortality and time to consultation after admission decreased.