Infants in critical care: the very worrying findings of intensivists

It is a cry of alarm launched by the French Society of Neonatology: while neonatal mortality has been increasing for ten years in France, the number of intensive care beds to care for the most fragile babies is “insufficient and unevenly distributed across the territory,” explains the learned society in a report published Monday.

Experts have conducted several surveys since the end of 2021, exploring the provision of care (in neonatology and critical care) and the quality of life at work of the professionals who work there. And they consider the results “very worrying”. The number of neonatal intensive care beds, already insufficient, is being reduced due to closures linked to lack of staff while more and more premature babies are taken care of and the rate of pregnancies continued despite a serious fetal malformation is also increasing. in (200% in ten years, according to the Biomedicine Agency). The beds are also very unevenly distributed across the territories: it varies “from single to double” depending on the region (from 0.6 to 1.28 beds per 1000 births, and from 0.96 to 2.84 overseas) . The worst-off metropolitan region is Provence-Alpes-Côte-d’Azur, and the southern half of the country is generally worse off than the northern half.

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Consequence: “Occupancy rates are very high”, generally above 90%, or even 100% “around 20% of the time”. However, “high occupancy rates are associated with an increase in the risk of severe morbidity and mortality in very premature babies,” warns the learned society. During a survey conducted in February 2023, 23% of the services questioned said they “regularly refuse critical entries due to lack of space”. It has become common during bronchiolitis epidemics to see the alert level exceeded and babies being hospitalized very far from home, due to lack of space where they were born. This was particularly true during the winter of 2022-2023.

As everywhere in hospitals, caregivers suffer from a degraded quality of life at work and a shortage of staff. 80% of the services surveyed are struggling to fulfill their on-call schedules, and “at least one pediatric neonatologist position is vacant in 73% of type 3 services” i.e. those authorized to receive the most vulnerable newborns. at risk. 80% of the 721 pediatric neonatologists who responded said they worked more than 50 hours per week, and 13% more than 75 hours! An exhausting pace of work, which pushes some to consider giving up. The situation is no better for nurses: in eight out of ten departments, at least a third of the workforce has less than 2 years of experience, even though this is the duration considered necessary to be fully competent in these areas. very special services. But they struggle to retain their staff. And the numbers remain insufficient: the ratio between actual nursing numbers and desirable theoretical numbers is less than 1 between 60 and 70% of days, depending on the criteria used.

This sad observation is made while the infant mortality figures are not good and are deteriorating in France, experts point out: since 2012, the number of neonatal deaths has been increasing and higher than the European average since 2015. “With a excess of around 1,200 deaths each year, France, which was in 3rd position among the countries with the lowest infant mortality in Europe between 1996 and 2000, is now in 20th position,” they write, citing statistics from INSEE, INED and Europeristat. First victims: infants less than one month old (74% of deaths, compared to 65% in 2005). Various hypotheses are put forward to explain these poor results, starting with the increase in risk factors (age of the mother, increase in multiple pregnancies, precariousness, etc.). Conversely, the good results of the Nordic countries, which are distinguished by a very low stillbirth rate (2.2 to 2.5 deaths per 1000 births in 2019 for Denmark, Finland and Norway, compared to 3.6 in France ) could be explained in particular by better “inclusion of parents as care partners” (hospitalization in family rooms, developmental care programs centered on the child and family, etc.).