Mother–infant pairs admitted to ICU have poor outcomes

By Sarah Guy, medwireNews Reporter

Mother-baby pairs with co-admission to intensive care units (co-ICUs) after delivery are more likely to experience separation due to interfacility transfer, and have higher mortality rates, than pairs in which either mothers or babies are admitted, show study results.

The findings indicate that co-ICU admission is more common than admission of the mother only, and that the mortality risk for mother and infant continues to be significantly elevated up to 1 year after birth.

"Coordination and communication of care plans between the adult and neonatal ICUs could lessen the burden and frequency of separation of mother and newborn seen with co-ICU admissions," suggest Joel Ray (University of Toronto, Ontario, Canada) and colleagues.

"Regionalized obstetric programs could be equipped to take care of both a sick mother and a sick newborn," they write in the Canadian Medical Association Journal.

Of the 1,023,978 singleton births that occurred in Ontario, Canada between April 2002 and March 2010 and were included in the study, a total of 1216 mother-infant pairs were admitted to the ICU.

More than half (57.5%) of the 2113 mothers admitted to an ICU during this period also had an infant admitted, while just 1% of the 124,452 infants admitted also had a mother admitted.

Separation of mother and infant as a result of interfacility transfer was 30.8 times more common in the co-ICU pairs than the no-ICU pairs (n=898,629), and was also more common compared with the maternal ICU-only and neonatal ICU-only pairs.

Short-term infant mortality (<28 days postpartum) was higher among co-ICU pairs than the neonatal ICU and no-ICU pairs, at 18.1 versus 7.6 and 0.7 deaths per 1000, respectively, and co-ICU admission was associated with a 19.4-fold increased risk for infant death in the year after birth.

The same trend emerged for short-term maternal mortality, with higher rates among co-ICU pairs than maternal only ICU and neonatal only ICU pairs, at 15.6 versus 6.7 and 0.2 deaths per 1000, respectively.

Mothers in co-ICU admission pairs had a 109.9-fold increased risk for death after 1 year compared with those with no ICU admission. "Discharge planning and post-hospital care may need to be coordinated to deal with a recovering mother and her newborn," conclude the authors.

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