Mother–baby intensive care admission carries high mortality risk

By Piriya Mahendra, medwireNews Reporter

Mothers and newborns who are both admitted to an intensive care unit (ICU) are significantly more likely to die than mother-baby pairs who are not, a study suggests.

Moreover, mother-baby pairs who need intensive care are likely to be admitted to different hospitals, negatively impacting on maternal-infant bonding, report researchers in the Canadian Medical Association Journal.

"In addition to being at high risk of death, newborns admitted to the neonatal ICU (NICU) experience long-term morbidity," remarked lead author Joel Ray (University of Toronto, Canada) in a press statement. "This produced a great deal of stress for the parents."

The population-based study of 1,023,978 singleton live births in Ontario, Canada between April 2002 and March 2010 revealed that the prevalence of concurrent admission of a mother and her newborn to separate ICUs (defined as co-ICU admission) was 1.2 per 1000 live births. This incidence was higher than that of maternal ICU admissions only, at 0.9 per 1000 live births.

Separation of a mother and her newborn because one or both needed to be transferred to another hospital was 30.8 times more common in co-ICU mother-baby pairs than those who were not admitted to an ICU.

Short-term infant mortality (defined as death <28 days after birth) was higher in babies in the co-ICU group, at 18.1 per 1000 live births, than in NICU babies whose mothers were not admitted to an ICU, at 7.6 per 1000 live births, and compared with mother-baby pairs who were not admitted to an ICU, at 0.7 per 1000 live births.

Short-term maternal mortality (<42 days after birth) was also higher in the co-ICU group, at 15.6 per 1000 live births, than in the maternal ICU group, at 6.7 per 1000 live births, or in mothers whose babies only were admitted to an NICU, at 0.2 per 1000 live births.

"Abnormalities of the maternal and fetal placental circulation may often co-exist, and a diseased placenta may adversely affect mother and fetus alike," say the authors. "Placental dysfunction may result in preeclampsia, placental abruption and placental infarction, paralleled by an increased rate of preterm cesarean delivery and involvement of the maternal hepatic, cardiac, renal and cerebral systems."

Ray and team suggest that coordination of care plans by ICU staff for mothers and babies in their respective ICUs, especially by trained social workers, as well as efforts to transfer mothers and babies to the same hospital may help lessen the burden of maternal-newborn separation.

"Co-ICU admission may be one optimal marker of maternal and infant mortality beyond maternal ICU or NICU admission alone," they conclude.

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