Background: Adult studies have shown that nursing overtime and unit overcrowding is associated with increased adverse patient events but there exists little evidence for the Neonatal Intensive Care Unit (NICU).

Objectives: To predict the onset on nosocomial infections and medical accidents in a NICU using machine learning models.

Subjects: Retrospective study on the 7,438 neonates admitted in the CHU de Québec NICU (capacity of 51 beds) from 10 April 2008 to 28 March 2013. Daily administrative data on nursing overtime hours, total regular hours, number of admissions, patient characteristics, as well as information on nosocomial infections and on the timing and type of medical errors were retrieved from various hospital-level datasets.

Methodology: We use a generalized mixed effects regression tree model (GMERT) to elaborate predictions trees for the two outcomes. Neonates’ characteristics and daily exposure to numerous covariates are used in the model. GMERT is suitable for binary outcomes and is a recent extension of the standard tree-based method. The model allows to determine the most important predictors.

Results: DRG severity level, regular hours of work, overtime, admission rates, birth weight and occupation rates are the main predictors for both outcomes. On the other hand, gestational age, C-Section, multiple births, medical/surgical and number of admissions are poor predictors.

Conclusion: Prediction trees (predictors and split points) provide a useful management tool to prevent undesirable health outcomes in a NICU.