Advanced Neonatal Medicine in China: A National Baseline Database

Abstract

Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure. The goal of the present study was to develop a national database of neonatal care units and compare present outcomes data in conjunction with health care practices and costs. We summarized the above components by extracting data from the databases of the national key clinical subspecialty proposals issued by national health authority in China, as well as publicly accessible databases. Sixty-one newborn clinical units from provincial or ministerial hospitals at the highest level within local areas in mainland China, were included for the study. Data were gathered for three consecutive years (2008–2010) in 28 of 31 provincial districts in mainland China. Of the 61 newborn units in 2010, there were 4,948 beds (median = 62 [IQR 43–110]), 1,369 physicians (median = 22 [IQR 15–29]), 3,443 nurses (median = 52 [IQR 33–81]), and 170,159 inpatient discharges (median = 2,612 [IQR 1,436–3,804]). During 2008–2010, the median yearly investment for a single newborn unit was US$344,700 (IQR 166,100–585,800), median length of hospital stay for overall inpatient newborns 9.5 (IQR 8.2–10.8) days, median inpatient antimicrobial drug use rate 68.7% (IQR 49.8–87.0), and median nosocomial infection rate 3.2% (IQR1.7–5.4). For the common newborn diseases of pneumonia, sepsis, respiratory distress syndrome, and very low birth weight (<1,500 grams) infants, their lengths of hospital stay, daily costs, hospital costs, ratios of hospital cost to per-capita disposable income, and ratios of hospital cost to per-capita health expenditure, were all significantly different across regions (North China, Northeast China, East China, South Central China, Southwest China, and Northwest China). The survival rate of extremely low birth weight (ELBW) infants (Birth weight <1,000 grams) was 76.0% during 2008–2010 in the five hospitals where each unit had more than 20 admissions of ELBW infants in 2010; and the median hospital cost for a single hospital stay in ELBW infants was US$8,613 (IQR 8,153–9,216), which was 3.0 times (IQR 2.0–3.2) the average per-capita disposable income, or 63 times (IQR 40.3–72.1) the average per-capita health expenditure of local urban residents in 2011. Our national database provides baseline data on the status of advanced neonatal medicine in China, gathering valuable information for quality improvement, decision making, longitudinal studies and horizontal comparisons.

Economic assessment of neonatal intensive care

“…Liao's paper discussed the overall Chinese government's overall investment for newborn care in the years 2008-2010 to be of $100 million, with a median yearly investment of $377,500 to a single newborn unit, primarily for the purchase of medical equipment, scientific research, personnel training, and newborn ward reconstruction (31). The daily hospital cost for an ELBW infant was $188, hospital cost of the average length of stay of about 49 days was $9,432 as found in five hospitals in four metropolitan cities.…”

“…The lower cost compared to developed countries is attributed by the authors as due to insufficient health staff and difference in service quality and shorter duration of stay. Survival rate ELBW above 500 gm birth weight was 76% in the 5 hospitals where high quality health professionals, advanced equipment and research funding was concentrated (31), as compared to the average survival rate ELBW 41% and VLBW 82% in 109 hospitals in year 2009 in other parts of China (32). The NICU costs were three times that of per capita disposable income of local urban residents, and almost 63 times the per capita health expenditure in 2011 (31).…”

Epidemiology of ROP update – Africa is the new frontier

“…1 The epidemic is now affecting countries in East and South Asia, following an increase in the provision of care for sick newborns, including those born preterm. [2][3][4] The third epidemic has already started in South Africa, 5 which like many countries in Latin America and Eastern Europe, is an upper MIC. Some of the more advanced economies in Africa, such as Ghana, Nigeria and Kenya are beginning to establish ROP screening and treatment services as intensive neonatal care starts to expand.…”

An evaluation of preterm kidney size and function over the first two years of life

“…Preterm birth accounts for 11% of births worldwide [1], and with increased investment in perinatal health among developing countries, the number of these infants surviving to adulthood is likely to increase [2]. Interventions such as antenatal steroids have improved survival [3], but the contribution of the oligonephropathy of prematurity [4] and its impact on the global burden of chronic kidney diseases (CKD) remain to be determined.…”