Mortality and Morbidity of Infants Born Extremely Preterm at Tertiary Medical Centers in China From 2010 to 2019

Zhu, Zhicheng; Lin, Yuan; Wang, Jin; Li, Qiuping; Yang, Chuanzhong; Gao, Xirong; Chen, Shangqin; Han, Song; Liu, Jiang-Qin; Wu, Hui; Yue, Shaojie; Shi, Jingyun; Cheng, Rui; Cheng, Xiuyong; Han, Tao; Jiang, Hong; Bao, Lei; Chen, Chao

doi:10.1001/jamanetworkopen.2021.9382

Cited by 64 publications

(68 citation statements)

References 48 publications

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“…We found that preterm infants admitted to NICUs in eastern China were at the lowest risks of death, whereas infants in western China had the highest mortality. Several studies have reported a similar disparity of maternal, child, and neonatal mortality from eastern to western China (1)(2)(3)(20)(21)(22)(23). Overall, inadequate health service infrastructures and low health expenditure due to less developed economic status are thought to have resulted in inequity in neonatal and child health in the western region (2,23).…”

Section: Discussionmentioning

confidence: 98%

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Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

et al. 2021

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Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions.Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions.Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China.

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Section: Discussionmentioning

confidence: 98%

“…DAMA is a critical cause related to mortality in China ( 22 , 26 ). Our results identified that 17.7% of infants in western China were DAMA, the highest among all regions, contributing to the highest rate of overall mortality in western China.…”

Section: Discussionmentioning

confidence: 99%

Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

et al. 2021

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“…While for infants ≤ 28 weeks, our LOS was approximately 10 days shorter compared with those reported by England and other 11 developed countries [ 9 , 25 ]. One possible explanation for shorter LOS in China may be relatively lower survival rates of infants with the smallest gestational age [ 27 ]. Greater survival in developed countries may result in more infants with morbidities associated with prolonged LOS.…”

Section: Discussionmentioning

confidence: 99%

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

et al. 2022

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Background This study aimed to describe length of stay (LOS) to discharge and site variations among very preterm infants (VPIs) admitted to 57 Chinese neonatal intensive care units (NICUs) and to investigate factors associated with LOS for VPIs. Methods This retrospective multicenter cohort study enrolled all infants < 32 weeks’ gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network, within 7 days after birth in 2019. Exclusion criteria included major congenital anomalies, NICU deaths, discharge against medical advice, transfer to non-participating hospitals, and missing discharge date. Two multivariable linear models were used to estimate the association of infant characteristics and LOS. Results A total of 6580 infants were included in our study. The overall median LOS was 46 days [interquartile range (IQR): 35–60], and the median corrected gestational age at discharge was 36 weeks (IQR: 35–38). LOS and corrected gestational age at discharge increased with decreasing gestational age. The median corrected gestational age at discharge for infants at 24 weeks, 25 weeks, 26 weeks, 27–28 weeks, and 29–31 weeks were 41 weeks, 39 weeks, 38 weeks, 37 weeks and 36 weeks, respectively. Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals. Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents. Large variation of LOS independent of infant characteristics existed, indicating variation of care practices requiring further investigation and quality improvement.

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“…NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome and its downstream Caspase 1, regulated the production of inflammatory molecules such as IL-1β ( 17 ), and miR-34a suppression reduces lung inflammation and apoptosis in an LPS-induced acute lung damage mouse model, indicating that miR-34a may mediate inflammasome activation ( 18 ). Except IL-1β, miRNA-34a also up-regulates TNF-α, IL-6, and Ang-1 production in animal or cell model ( 11 , 19 – 21 ), which all are proinflammatory factors that closed relate with progress of BPD. However, the dynamics of these pro-inflammatory cytokines during the development of BPD in preterm infants and their role in BPD have not been reported in detail.…”

Section: Introductionmentioning

confidence: 99%

Hyperoxia Induced Bronchopulmonary Dysplasia-Like Inflammation via miR34a-TNIP2-IL-1β Pathway

Tao

Zeng

2022

Front. Pediatr.

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Lung injury induced by oxygen is a key contributor to the pathogenesis of preterm infant bronchopulmonary dysplasia (BPD). To date, there are comprehensive therapeutic strategy for this disease, but the underlying mechanism is still in progress. By using lentivirus, we constructed microRNA34a (miR34a)-overexpressing or knockdown A549 cell lines, and exposure to hyperoxia to mimic oxygen induce lung injury. In this study, we investigated 4 proinflammatory cytokines, interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), angiopoietin-1 (Ang-1), and Cyclooxygenase-2 (COX-2) in the secreted sputum of infants who received mechanical ventilation, and found that IL-1β was substantially elevated in the first week after oxygen therapy and with no significant decrease until the fourth week, while TNF-α, Ang-1, and COX-2 were increased in the first week but decreased quickly in the following weeks. In addition, in vitro assay revealed that hyperoxia significantly increased the expression of miR-34a, which positively regulated the proinflammatory cytokine IL-1β in a time- and concentration-dependent manner in A549 cells. Overexpressing or knockdown miR34 would exacerbate or inhibit production of IL-1β and its upstream NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) inflammasome signaling pathway. Mechanically, it’s found that TNFAIP3 interacting protein 2 (TNIP2), an inhibitor of nuclear factor κB (NF-κB), is a direct target of miR34a, negatively regulated activation of NLRP3 inflammasome and the production of IL-1β. Overexpressing TNIP2 ameliorated hyperoxia-induced production of IL-1β and cell apoptosis. Our findings suggest that TNIP2 may be a potential clinical marker in the diagnosis of BPD.

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Mortality and Morbidity of Infants Born Extremely Preterm at Tertiary Medical Centers in China From 2010 to 2019

Abstract: This cohort study examines the association of preterm birth with risk of mortality and morbidity among infants born in China from 2010 to 2019.

Cited by 64 publications

References 48 publications

Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Hyperoxia Induced Bronchopulmonary Dysplasia-Like Inflammation via miR34a-TNIP2-IL-1β Pathway

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