Care Practices, Morbidity and Mortality of Preterm Neonates in China, 2013–2014: a Retrospective study

Abstract

This retrospective cohort study aimed to investigate the prevalence, morbidity, mortality and the maternal/neonatal care of preterm neonates and the perinatal risk factors for mortality. We included data on 13,701 preterm neonates born in 15 hospitals for the period 2013–2014 in China. Results showed a prevalence of preterm neonates of 9.9%. Most infants at 24–27 weeks who survived more than 12 hours were mechanically ventilated (56.1%). Few infants born before 28 weeks received CPAP without first receiving mechanical ventilation (8.1%). Few preterm neonates received antenatal steroid(35.8% at 24–27 weeks, 57.9% at 28–31 weeks, 57.0% at 32–33 weeks and 32.7% at 34–36 weeks). Overall mortality was 1.9%. Most of the deaths at 24–27 weeks of gestation occurred within 12 hours after birth, accounting for 68.1%(32/47), and within 12–72 hours after birth at 28–36 weeks of gestation, accounting for 47.4%(99/209). Rates of survival to discharge increased from 68.2% at 24–27 weeks, 93.3% at 28–31 weeks, 99.2% at 32–33 weeks to 99.4% at 34–36 weeks. The smaller of the GA, there was a greater risk of morbidities due to prematurity. Preterm birth weight (OR = 0.407, 95% CI 0.346–0.478), antenatal steroid (OR = 0.680, 95% CI 0.493–0.938), and neonatal asphyxia (OR = 3.215, 95% CI 2.180–4.741) proved to significantly influence the odds of preterm neonatal death. Overall, our results support that most of the preterm neonates at 28–36 weeks of gestation survived without major morbidity. Rate of survival of GAs less than 28 weeks was still low. Maternal and infant care practices need to be improved in the very preterm births.

Survival Status and Predictors of Mortality Among Preterm Neonates in Southwest Ethiopia: A Retrospective Cohort Study

“…In the current study, preterm neonates who had perinatal asphyxia (PNA) had a greater hazard of neonatal mortality than those preterm neonates without PNA. This nding is consistent with studies reported from China (22), Gonder (18,19,24), Woliata Sodo (23), Addis Ababa (52), and Jimma, Ethiopia (33,36). This consistency might be elucidated by similarity in study design, and follow-up period.…”

“…In the current study, preterm neonates born from mothers who used antenatal steroids had a lesser hazard of mortality than those neonates born from mothers who did not use antenatal steroids. This nding is in line with studies reported in the United States (20) and China (21,22). This could be explained by the fact that the administration of steroids for mothers who had imminent preterm delivery enhances fetal lung maturity and decreases the risk of developing respiratory distress syndrome and intraventricular hemorrhage, and consequently might reduce the risk of neonatal death (48).…”

Therapeutic Effects and Outcomes of Rescue High-Frequency Oscillatory Ventilation for Premature Infants With Severe Refractory Respiratory Failure

“…Similar to previous studies, we found none of speci c pulmonary diseases was independently associated with the nal outcome [35][36][37]. However, previous studies found mortality was not correlated with lower birth body weight, which may be due to different study population, different therapeutic interventions and various de nition of respiratory failure [35][36][37]. Besides, our data also highlights the important role of initial-HFOV patient characteristics and aggressive treatment of sepsis to prompt neonates toward optimized outcomes.…”

“…In this study, we analyzed a wide variety of patients (i.e., neonates with RDS, severe BPD, and secondary pulmonary hypertension) together. Similar to previous studies, we found none of speci c pulmonary diseases was independently associated with the nal outcome [35][36][37]. However, previous studies found mortality was not correlated with lower birth body weight, which may be due to different study population, different therapeutic interventions and various de nition of respiratory failure [35][36][37].…”

Untitled

“…The predictors of mortality among preterm neonates born at MRRH were largely modifiable and ranged from prenatal, natal and postnatal predictors (lack of ANC attendance or late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). Similar findings have been reported from other studies of various settings [34,35,[41][42][43][44][45][46][47]. The predictors found in our study suggest that relatively simple interventions might improve the outcomes of the preterm neonates born at MRRH.…”