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premature baby 298.88.(Photo by: Courtesy)
Knesset panel criticizes neonatal units
JUDY SIEGEL-ITZKOVICH
11/04/2008
Israel Neonatology Society airs serious complaints of manpower, funding problems.
The Knesset Children's Rights Committee heard serious complaints by Israel Neonatology Society doctors on Tuesday about seriously inadequate manpower in the country's neonatal units, which has resulted in relatively high mortality rates among premature babies, the smallest of whom weigh only a few hundred grams. The society, headed by Prof. Michael Schimmel of Shaare Zedek Medical Center's neonatology department, said that today, the average neonatology unit nurse takes care or five or six - and even eight - tiny babies at a time instead of the four infants recommended by a committee of experts. The experts also recommend a ratio of one nurse to 1.5 babies in the neonatal intensive care units, but the average rate in Israel is also higher. He was backed up by Dr. Yitzhak Kadman, head of the Israel Council for the Child, in his complaints. Schimmel said that two years ago, the average official occupancy rates in Israeli neonatal units was over 84 percent - but that in fact, they reached 94.4%. This year, he added, the neonatal intensive care occupancy rates were over 125% in regular neonatal units and 159% in neonatal intensive care units. Schimmel said that a professional committee headed by ministry director-general Prof. Avi Yisraeli had recommended a maximum of 90% occupancy in regular neonatal units and 80% in neonatal intensive care units. The more crowded the units and the more babies taken care of by one nurse result in more infections and lower premature-baby survival rates. A few years ago, the State Comptroller dedicated part of a chapter on the Health Ministry to serious criticism of the level of care and conditions in premature baby units in the hospitals. The neonatal society chairman said the main problem is that the ministry does not define all neonatal units as neonatal intensive care units or set a higher standard for the required number of nurses and doctors working there. Shosh Riba, head of the ministry's nursing branch, told The Jerusalem Post on Tuesday night that the ministry has "worked hard to persuade the Treasury to allocate more money for neonatal units in government hospitals. We received NIS 25 million for equipment in the state hospitals and 26 job slots more per year for 2006 through 2010." Public hospitals owned by Clalit Health Services and voluntary organizations receive the same amount of funding, Riba said, but the owners and managements can decide independently how to spend it. Riba has not demanded a larger number of neonatologists (specialist physicians), as she supervises only nursing; there are currently negotiations going on between the Treasury and the Israel Medical Association, she said. "But studies show clearly that there is a direct connection between the number of nurses in neonatal units and the level of infection." There is a general shortage of nurses in Israel, including on neonatal units, but she reported there there is no significant "dropout" phenomenon among neonatal unit nurses despite the fact that the work is intensive and very demanding. Committee chairman MK Nadia Hilou summarized that the Health Ministry "must ensure that the necessary resources reach the neonatal departments in hospitals" owned by Clalit and the voluntary organizations and find a mechanism for supervising them. In addition, the Treasury and the Health Ministry must accept recommendations of the professional committees and recognize neonatal units as intensive care units regarding manpower slots filled with suitable nurses and doctors."
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