2023-10-09 20:33:31
The French Society of Neonatology published this Monday the results of an audit on the provision of neonatal care, particularly critical care. She points out in particular high occupancy rates and understaffed teams.
Is the reception of babies requiring critical care one of the factors explaining the increase in early neonatal mortality? According to a study by researchers from Inserm, the University of Paris, AP-HP and Nantes University Hospital, published in March 2022, since 2012, France has experienced a significant increase in the infant mortality rate.
“This 7% increase increased infant mortality from 3.32 in 2012 to 3.56 deaths per 1000 live births in 2019,” Inserm then noted in a press release. A trend driven by an increase in early neonatal mortality (children born alive and dying within the first 7 days of life).
A “deterioration of the care circuit”
Faced with this alarming observation, the French Society of Neonatology (SFN), a learned society bringing together professionals working around newborns, carried out an audit between 2021 and 2023 in order to evaluate the provision of neonatology care, in particular critics in the country. She revealed the main findings in a press release on Monday.
Among the hypotheses which can explain the increase in neonatal mortality, the SFN cites “the increase in the age of mothers at the time of childbirth, the increase in multiple pregnancies, situations of precariousness or even a deterioration of the circuit of care”. The results of the SFN investigation into the provision of critical care in neonatology are “very worrying”, she warns.
Lack of space and understaffing
She first observed a number of neonatal intensive care beds per 1,000 births ranging from single to double depending on the region of the metropolis. Overall, “the supply of neonatal critical care remains insufficient”, warns the SFN, with very high occupancy rates on average.
In addition to this lack of space, these services are often understaffed. “At least one pediatric neonatologist position is vacant in 73% of type 3 services, and two or more are vacant in 46% of services,” according to the SFN.
75-hour weeks for some
As a result, among the 721 pediatric neonatologists (out of an estimated total of approximately 1,500) who responded to the learned society’s survey on their quality of life at work, 80% reported working more than 50 hours per week, and 13% more than 75 hours per week.
Working conditions that have an impact on their personal life: 49% of neonatologists surveyed said they had sleep problems related to their work, and 17% said they had experienced an episode of burn-out or depression. “The main reasons for job dissatisfaction are excessive working hours and insufficient remuneration of guards,” explains the SFN.
A lack of seniority and training of nurses
This also highlights the lack of seniority of the nursing teams, to which is added “a lack of initial training in pediatrics and neonatology, which have been entirely removed from the teaching program of the State diploma of nurse in 2009.
“There is enormous pressure on the teams,” lamented to the Monde Elsa Kermorvant, vice-president of the SFN and neonatologist at Necker hospital in Paris. “We are constantly playing musical chairs to distribute the newborns who need it, we take a baby out of intensive care faster than we would like, we transfer to other hospitals… But that is not possible to postpone births when they reach term,” she added.
The French Society of Neonatology is therefore calling for a review of the organization of critical care in neonatology.
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