Too few intensive care cots for newborns to cope with demand

September 21, 2000

National census of availability of neonatal intensive care

Demand for neonatal intensive care in the UK outstrips supply, finds research in this week's BMJ.

Field and colleagues conducted a census on the availability of neonatal intensive care in the UK's 37 largest regional perinatal centres dealing with high risk births. The study ran between April and June last year.

During the three months of the study, 309 transfers were made, equivalent to over 1200 a year, of which 264 were made before the baby had been born. Sixty five of these transfers involved a multiple birth. The most common reason given for the transfer was lack of neonatal beds, which includes lack of appropriate staff and equipment even if the bed is empty, rather than inability of the centre to provide the service. Regions differed considerably in their ability to cope with demand, with the highest numbers of transfers in Wales with a rate of 5.24 per 1000 births, followed closely by the South and West region, with a rate of 5.16, and the Trent region with a rate of 3.52.

Most deliveries in the UK take place in district general hospitals, but when delivery units are full or there are complications, these hospitals will refer to perinatal units. But, say the authors, the findings of this study indicate that they will find considerable difficulty in obtaining a place. And anecdotal evidence suggests the problem is growing, say the authors.

Transfers will always be part of obstetrics, say the authors, and there is no evidence to suggest that the health of either mothers or their babies is compromised by these transfers. But the psychological and financial burdens borne by the families involved are considerable, they say. National standards or targets set for the NHS, and a comprehensive nationwide strategy to deal with high risk perinatal care are needed to alleviate the "chaotic" situation.

Dr Janet Rennie, King's College Hospital, London

Professor Philip J Steer, Chelsea & Westminster Hospital, London


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