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Infant to staff ratios and risk of mortality in very low birth weight infants

We were very interested to read the article by Callaghan and colleagues.1 They report a decline in mortality with less nurses caring for high risk infants over the first three days of life. This is a surprising finding, which is counter-intuitive to established neonatal wisdom. Indeed the authors quote a smaller study by Hamilton and colleagues,2 which found an increase in mortality with a reduced ratio of nurses to infants. Callaghan and colleagues’ findings may be true, with the most likely explanation of the deaths being excessive handling. Clearly, if this finding is replicated, then establishing the optimum number of nurses could lead to improved outcomes for high risk …