Critical Newborn Assistance in Intensive Care Units: Model and Simulation

Since 1970’s in many European countries and in North America perinatal cares are organized by local regions according to three hospital levels, corresponding to structural characteristics and to offered professional abilities; the same three levels are defined for obstetric units; in a hospital we always have obstetric and neonatal assistance units of the same level, and moreover if an upper level unit is activated, all lower level units are activated too; thus we have most hospitals with first level units, some hospitals with first and second level units and few hospitals with first, second and third level units. First level neonatal assistance units take care of newborns without ascertained pathologies, born after more than 34 gestation weeks. Second level units assist newborns characterized by mild pathologies or weight over 1500 grams, or born after more than 32 gestation weeks. Third level units generally include an intensive care unit and a sub-intensive care unit; the intensive care units assist newborns needing artificial ventilation, surgical newborns before and after surgical operations, newborns with less than 32 gestation weeks, newborns with complex malformations and/or needing invasive or specific diagnostic procedures; the sub-intensive care units assist newborns after admission in the intensive care units, after their reaching better health conditions, but not yet admissible in a second level unit. Each third level intensive or sub-intensive care unit is characterised by the number of places at disposition, depending on the number of special incubators and on the active specialised doctors and nurses. Birth is generally planned in a birth centre which corresponds to expected newborn conditions, on the basis of pregnancy course; however newborn conditions may present a sudden unforeseen worsening, and therefore require a quick transfer to an upper level neonatal unit. In the present paper we build up a simulation model describing third level newborn generation and movement among existing assistance structure with the aim of detecting the whole assistance network critical points and to suggest suitable adaptation by resizing structure assistance capacities, both in the current situations and in future scenarios.