IATROGENESIS IN THE NICU

Kugelman A, Inbar-Sanado E, Shinwell ES, et al. Iatrogenesis in neonatal intensive care units: observational and interventional, prospective, multicenter study. Pediatr 2008;122:550-555. [Full text] [PDF]

Objective. The goals were to determine the incidence of iatrogenic events in NICUs and to determine whether awareness of iatrogenic events could influence their occurrence.

Methods. We performed a prospective, observational, interventional, multicenter study including all consecutive infants hospitalized in 4 NICUs. In the first 3 months (observation period), the medical teams were unaware of the study; in the next 3 months (intervention period), they were made aware of daily ongoing monitoring of iatrogenic events by a designated "Iatrogenesis Advocate."

Results. Although the prevalence rates of iatrogenic events were comparable in the observation and intervention periods (18.0 and 18.2 infants with iatrogenic events per 100 hospitalized infants, respectively), the incidence rate decreased significantly during the intervention period (3.2 and 2.4 iatrogenic events per 100 hospitalization days of new admissions, respectively). Of all iatrogenic events, 7.9% were classified as life-threatening and 45.1% as harmful. For younger and smaller infants, the rate of iatrogenic events was higher (57% at gestational ages of 24 to 27 weeks, compared with 3% at term) and the iatrogenic events were more severe and harmful. Increased length of stay was associated independently with more iatrogenic events.

Conclusions. Neonatal medical teams and parents should be aware of the burden of iatrogenesis, which occurs at a significant rate.

Comments. This is yet another study that demonstrates that when patients are admitted to a NICU they enter a high risk environment. I agree with the authors' statement that "although iatrogenesis may be inevitable, it certainly should not be acceptable". Systematic recognition and analysis of iatrogenic events should become standard in every NICU and the provision of the necessary resources should have a high priority. I am convinced that such systems would have a large potential for improvement of patient safety and outcome. TMB

Date: 04 Mar 2009
Time: 09:14:37

Along with Systematic recognition and analysis of iatrogenic events, Evidence Based Practice should decrease the incidence of Iatrogenesis. In this day and age "Eminence based Medicine or Anecdotal Medicine has no place in Neonatal-Perinatal Medicine!

UserName: Ravi Agarwal, MD
Institution: Sheridian Healthcare
telephone: 8504960855
email: neodoc1@yahoo.com