Initial respiratory support modality and outcome in preterm infants with less than 32 weeks of gestation in China: A multicentre retrospective cohort study

Wang, Li; Li, Jia-hui; Yu, Yonghui; Huang, Lei; Huang, Xiaoyang; Fan, Xiu-fang; Zhang, Xiaohui; Zhang, Chunlei; Liu, Qiang; Sun, Airong; Zhang, Yongfeng; Cao, Yang-yang; Xu, Ping; Liu, Xiuxiang; Wu, Jing-cai; Yang, Zhenying; Sun, Rongrong; Ren, Xueyun; Li, Jing; Xiaoli, Wan; Qiu, Bing-ping; Niu, Shiping; Zhu, Renxia; Wang, Xiaokang; Yihui, Zhang; Gao, Yanling; Deng, Liping; Shi, Jing; Bi, Minghong

doi:10.1111/ppe.12801

Cited by 5 publications

(10 citation statements)

References 29 publications

(78 reference statements)

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“…In the current study, neonates diagnosed with respiratory distress syndrome (RDS) were found to have an increased risk of hazards and a shorter time to death from sepsis compared to their counterparts. This observation aligns with findings from previous studies conducted globally, in China, Northwest Ethiopia, and Felegehiwot Comprehensive Hospital ( 8 , 24 , 25 , 26 ). The prevalence of RDS as a complication among preterm neonates is attributed to respiratory organ immaturity ( 18 ).…”

Section: Discussionsupporting

confidence: 92%

“…Preterm neonates diagnosed with sepsis exhibit a two-fold shorter time to death compared to term babies. This trend is consistent with findings from a multisite prospective study conducted across low- and middle-income nations ( 22 ), as well as global research conducted in China, Brazil, India, and northwest Ethiopia ( 8 , 21 , 23 , 24 , 25 ). A plausible explanation is that premature newborns are more susceptible to infections due to the immaturity of vital organs and their immune systems ( 18 ).…”

Section: Discussionsupporting

confidence: 90%

“…Furthermore, premature infants often require specialized continuous care, including surfactant drug administration, cooling therapy, and advanced support such as extracorporeal membrane oxygenation ( 4 ). However, critical services like these are often limited in developing countries ( 24 , 25 ), leading to an increased risk of hazards and resulting in a shorter time to death among neonates affected by sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia

Wudu,

Bekalu,

Wondifraw

et al. 2024

Front. Pediatr.

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BackgroundIn impoverished nations like Ethiopia, neonatal sepsis contributes significantly to neonatal mortality. Despite variations in the specific timing of death and predictors of neonatal mortality associated with sepsis across different settings, there's limited documented information in the Neonatal Intensive Care Units of northeastern Ethiopia. Consequently, the aim of this study was to determine time to death and its predictors among neonates with sepsis admitted to Neonatal Intensive Care Units in comprehensive specialized hospitals in northeastern EthiopiaMethodsA prospective cohort study conducted at the institution level involved 306 neonates diagnosed with sepsis. Data collection utilized face-to-face interviews and chart reviews. Subsequently, the data were inputted into Epi-data version 4.6 and later analyzed using STATA version 17. The median time to death was determined, and both the Kaplan-Meier curve and log-rank test were applied. Furthermore, a Cox proportional hazard regression model was utilized to identify predictors of neonatal mortality associated with sepsis.ResultThe cumulative incidence of mortality among neonates admitted with sepsis was 34% (95% CI: 28.9%–39.5%). The neonatal mortality rate stood at 51 (95% CI: 42.1, 62) per 1,000 neonates admitted to the intensive care units with sepsis over a total of 1,854 person-days of observation. Additionally, the median time to death was 13 days (IQR = 5–23 days). Tachypnea [AHR 6.2 (95% CI: 1.5–9.7)], respiratory distress syndrome [AHR 2.1 (95% CI: 1.3–3.5)], lethargy [AHR 1.8 (95% CI: 1.2–2.6)], preterm birth [AHR 1.8 (95% CI: 1.2–2.7)], continuous positive airway pressure use [AHR 2.1 (95% CI: 1.3–3.4)], home delivery [AHR 2.63 (95% CI: 1.1–6.4)], Subgalea hemorrhage [AHR 1.8 (95% CI: 1.1–3.9)], and low platelet count [AHR 5.9 (95% CI: 2.3–8.6)] were found to be predictors of time to death in neonates with sepsis.ConclusionThe study revealed an alarmingly high neonatal mortality rate among septic neonates, underscoring the urgency for intervention. Enhancing the quality of care in neonatal intensive care units, bolstering infection prevention during procedures such as continuous positive airway pressure, exercising caution with locally made accessories, and reinforcing a culture of institutional delivery are critical in curbing neonatal sepsis-related mortalities.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia

Wudu,

Bekalu,

Wondifraw

et al. 2024

Front. Pediatr.

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“…We established the Sina-northern Neonatal Network (SNN) database and its online website ( www.snn-med.com ), and our previous study showed that about 41.9% of preterm infants [< 32 weeks of gestational age (GA)] received initial IMV. The incidence of BPD in the noninvasive ventilation failure group of very preterm infants can reach up to 37.6% [ 11 ]. The difference is statistically significant compared with that of the successful noninvasive ventilation receiving subjects, suggesting that the respiratory management of preterm infants may be related to the occurrence of BPD.…”

Section: Introductionmentioning

confidence: 99%

Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study

Dou

Zhuo

et al. 2023

World J Pediatr

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Objectives We aimed to evaluate the risk factors for moderate-to-severe bronchopulmonary dysplasia (BPD) and focus on discussing its relationship with the duration of initial invasive mechanical ventilation (IMV) in very preterm neonates less than 32 weeks of gestational age (GA). Methods We performed a prospective cohort study involving infants born at 23–31 weeks of GA who were admitted to 47 different neonatal intensive care unit (NICU) hospitals in China from January 2018 to December 2021. Patient data were obtained from the Sina-northern Neonatal Network (SNN) Database. Results We identified 6538 very preterm infants, of whom 49.5% (3236/6538) received initial IMV support, and 12.6% (823/6538) were diagnosed with moderate-to-severe BPD symptoms. The median duration of initial IMV in the moderate-to-severe BPD group was 26 (17–41) days, while in the no or mild BPD group, it was 6 (3–10) days. The incidence rate of moderate-to-severe BPD and the median duration of initial IMV were quite different across different GAs. Multivariable logistic regression analysis showed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial IMV [adjusted odds ratio (AOR): 1.97; 95% confidence interval (CI): 1.10–2.67], late-onset neonatal sepsis (LONS), and patent ductus arteriosus (PDA). Conclusion In this multicenter cohort study, the duration of initial IMV was still relatively long in very premature infants, and the longer duration of initial IMV accounts for the increased risk of moderate-to-severe BPD.

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“…The risk factors for PH, such as smaller gestational age (GA), lower birth weight (BW), surfactant use, patent ductus arteriosus (PDA) and coagulopathy, have been described in previous studies (2)(3)(4). A prospective study found that continuous positive airway pressure (CPAP) failure was closely associated with PH (11). In recent years, with improvements in living conditions and the development of medical technology, the proportion of extremely premature infants (GA <28 weeks) entering neonatal intensive care units (NICUs) in our country has gradually increased (12,13).…”

Section: Introductionmentioning

confidence: 99%

Association between pulmonary hemorrhage and CPAP failure in very preterm infants

Wang

Zhao

et al. 2022

Front. Pediatr.

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BackgroundPulmonary hemorrhage (PH) in neonates is a life-threatening respiratory complication. We aimed to analyze the perinatal risk factors and morbidity with PH among very preterm infants in a large multicenter study.MethodsThis was a multicenter case–control study based on a prospective cohort. Participants included 3,680 in-born infants with a gestational age at 24–32 weeks (birth weight <1,500 g) who were admitted between January 1, 2019, and October 31, 2021. All infants were divided into two groups, namely, the PH and no-PH groups, at a ratio of 1:2 according to the following factors: gestational age (GA), birth weight (BW), and the Score for Neonatal Acute Physiology with Perinatal extension II (SNAPPE II). Perinatal factors and outcomes were compared between the two groups by logistic regression analyses.ResultsA total of 3,680 infants were included in the study, and the number of identified cases of PH was 262 (7.1%). The incidence was 16.9% (136/806) for neonates with extremely low BW (BW < 1,000 g) infants. The multivariate analysis showed that CPAP failure (OR 2.83, 95% CI 1.57, 5.08) was significantly associated with PH. PH was associated with a high likelihood of death (OR 3.81, 95% CI 2.67, 5.43) and bronchopulmonary dysplasia (BPD) (≥grade II) (OR 1.58, 95% CI 1.00, 2.48).ConclusionsIn this multicenter case–control study based on a prospective cohort, PH to be common among VLBW infants. PH is associated with significant morbidity and mortality, and perinatal management, especially CPAP failure. Respiratory management strategies to decrease the risk of PH should be optimized.

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Initial respiratory support modality and outcome in preterm infants with less than 32 weeks of gestation in China: A multicentre retrospective cohort study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 5 publications

References 29 publications

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia

Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study

Association between pulmonary hemorrhage and CPAP failure in very preterm infants

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