A birth population-based survey of preterm morbidity and mortality by gestational age

Abstract

Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

Perinatal Risks of Neonatal and Infant Mortalities in a Sub-provincial Region of China: A Livebirth Population-based Cohort Study

“…The need for in-hospital care was defined as admissions into any neonatal ward or NICU within neonatal period (0-27 postnatal days) for term births or within adjusted GA of preterm infants equivalent to 28 postnatal days for term births. All the above-mentioned perinatal and neonatal diagnoses or definitions were consistent with previous studies [ 11 – 15 ].…”

“…For those infant deaths without admission into, or after discharge from, any neonatal ward or NICU were classified as out-of-hospital deaths, which were derived from regional death report system (MCHSS) after verification of corresponding clinical records. By integrating the data of all infant deaths from the two sources, a new integrated database was established as a cohort linking information of livebirths, neonatal hospitalization and/or infant death for final analysis [ 15 ]. Works of retrospective data collection and analysis were conducted in 2018-2021.…”

“…The study protocol was approved by the ethics committee of Children’s Hospital of Fudan University, and adopted by the Huai’an Women and Children’s Hospital and all other participating hospitals in Huai’an [ 13 – 15 ]. As no specific intervention was applied, informed consent from parents/guardians was waived.…”

Clarithromycin prevents preterm birth and neonatal mortality by dampening alarmin-induced maternal–fetal inflammation in mice

“…Preterm birth is the leading cause of neonatal morbidity and mortality worldwide [ 1 – 3 ], with two-thirds of all cases preceded by spontaneous preterm labor [ 4 ]. The latter is a syndrome comprising multiple etiologies [ 4 , 5 ], with intra-amniotic infection and/or inflammation as the only well-established causal link to preterm birth [ 6 – 21 ].…”

Correction to: A birth population-based survey of preterm morbidity and mortality by gestational age

“…Following publication of the original article [ 1 ], the authors reported an error in Table 4 heading (continued) in the PDF version is incorrect, “A. The total preterm births” should be “B.…”