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Maternal and neonatal separation and mortality associated with concurrent admissions to intensive care units

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Background — Concurrent admission of a mother and her newborn to separate intensive care units (herein referred to as co-ICU admission), possibly in different centres, can magnify family discord and stress. The authors examined the prevalence and predictors of mother–infant separation and mortality associated with co-ICU admissions.

Methods — The authors completed a population-based study of all 1,023,978 singleton live births in Ontario between April 1, 2002 and March 31, 2010. The authors included data for maternal–infant pairs that had co–ICU admission (n = 1,216), maternal ICU admission only (n = 897), neonatal ICU (NICU) admission only (n = 123,236) or no ICU admission (n = 898,629). The primary outcome measure was mother–infant separation because of interfacility transfer.

Results — The prevalence of co-ICU admissions was 1.2 per 1,000 live births and was higher than maternal ICU admissions (0.9 per 1,000). Maternal–newborn separation due to interfacility transfer was 30.8 (95% confidence interval [CI] 26.9–35.3) times more common in the co–ICU group than in the no–ICU group and exceeded the prevalence in the maternal ICU group and NICU group. Short-term infant mortality (< 28 days after birth) was higher in the co–ICU group (18.1 per 1,000 live births; maternal age-adjusted hazard ratio [HR] 27.8, 95% CI 18.2–42.6) than in the NICU group (7.6 per 1000; age-adjusted HR 11.5, 95% CI 10.4–12.7), relative to 0.7 per 1000 in the no–ICU group. Short-term maternal mortality (< 42 days after delivery) was also higher in the co–ICU group (15.6 per 1,000; age-adjusted HR 328.7, 95% CI 191.2–565.2) than in the maternal ICU group (6.7 per 1000; age-adjusted HR 140.0, 95% CI 59.5–329.2) or the NICU group (0.2 per 1,000; age-adjusted HR 4.6, 95% CI 2.8–7.4).

Interpretation — Mother–infant pairs in the co–ICU group had the highest prevalence of separation due to interfacility transfer and the highest mortality compared with those in the maternal ICU and NICU groups.

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Citation

Ray JG, Urquia ML, Berger H, Vermeulen MJ. CMAJ. 2012; 184(18):E956-62. Epub 2012 Oct 22.

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