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Aims: There is well-established data linking the adequacy of nurse staffing to patient outcomes. Evidence-based standards for staffing are therefore critical to drive improvements in clinical care. One such evidence-based approach is the use of patient acuity-based tools. The objective of this study is to determine the performance of a neonatal acuity tool in an Australian tertiary neonatal health-care setting, focusing on the classification of patient acuity and nursing:patient staffing ratios compared to current practice., Methods: Acuity data were collected in a neonatal intensive care unit (NICU) and special care baby unit (SCBU) over a 10-week period in 2023. Patient data were scored in the 16 domains at two time points (prior to morning and evening nursing shift changeover) for all admitted newborns., Results: For ventilated newborns nursed with a nurse:patient staffing ratio of 1:1, 78% of scores were within the L4-high acuity (score ≥ 26) band, with the remaining scores within the L3-high acuity (18-25) band. For newborns on non-invasive respiratory support in NICU staffed 1:1, the proportion scoring within the L4 acuity band was higher in the nasal high-flow group compared to the nasal continuous positive airway pressure group (P = 0.032), an effect not seen for those nursed 1:2 in NICU or for those on nasal high-flow nursed in SCBU either 1:2 or 1:3., Conclusion: This study of how a neonatal acuity classification system compares with current nurse:patient staffing allocations in an Australian tertiary NICU, suggests refinements in staffing ratios for specific patient groups on respiratory support are possible., (© 2024 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: Neonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited physiological data to support recommendations in the neonatal intensive care unit (NICU). We aimed to determine the time to desaturation after ceasing spontaneous or assisted breathing in preterm infants undergoing elective endotracheal intubation in the NICU.Methods: Observational study at The Royal Women's Hospital, Melbourne. A secondary analysis was performed of video recordings of neonates ≤32 weeks' postmenstrual age undergoing elective intubation. Infants received premedication including atropine, a sedative and muscle relaxant. Apnoeic oxygenation time (AOT) was defined as the time from the last positive pressure or spontaneous breath until desaturation (SpO2 <90%).Results: Seventy-eight infants were included. The median (IQR) gestational age at birth was 27 (26-29) weeks and birth weight 946 (773-1216) g. All but five neonates desaturated to SpO2 <90% (73/78, 94%). The median (IQR) AOT was 22 (14-32) s. The median (IQR) time from ceasing positive pressure ventilation to desaturation <80% was 35 (24-44) s and to desaturation <60% was 56 (42-68) s. No episodes of bradycardia were seen.Conclusions: This is the first study to report AOT in preterm infants. During intubation of preterm infants in the NICU, desaturation occurs quickly after cessation of positive pressure ventilation. These data are important for the development of clinical guidelines for neonatal intubation.Trial Registration Number: ACTRN12614000709640. [ABSTRACT FROM AUTHOR]