Mortality of Neonatal Respiratory Failure Related to Socioeconomic Factors in Hebei Province of China

Abstract

Dramatic progress has occurred in neonatal intensive care in tertiary centers in mid-eastern China. We investigated the characteristics of neonatal respiratory failure (NRF) including the incidence, management, outcomes and costs in 14 neonatal intensive care units (NICUs) of Hebei, a province at an intermediate economic level in China. Over a period of 12 consecutive months in 2007–2008, perinatal data were collected prospectively from all NICU admissions (n = 11,100). NRF was defined as severe hypoxemia requiring respiratory support for more than 24 h, and was diagnosed in 1,875 newborns (16.9%). The average birth weight of newborns with NRF was 2,200 g (range 600–5,500 g), with 60.9% <2,500 g, and 2% <1,000 g. The male:female ratio was 2.6:1. The leading diagnosis was respiratory distress syndrome; 58.3% of newborns with respiratory distress syndrome received surfactant. Continuous positive airway pressure was used more than ventilation (73.3 vs. 49.1%,p < 0.001). Overall, the mortality rate until discharge was 31.4% (583/1,859). Most deaths (432, 74.1%) followed a parental decision to withdraw care. NRF mortality varied in association with different gross domestic product levels, family annual income and nurse-to-bed ratios. The median cost of a hospital stay was 10,169 CNY (interquartile range: 6,745–16,386) for NRF survivors. We conclude that, despite the available respiratory support in these emerging NICUs, the mortality of NRF remains. This was associated with prematurity, standard of care but also with socioeconomic factors affecting treatment decisions. Assessment of efficacy of respiratory support for NRF in such emerging neonatal services should account for both standard of care and socioeconomic conditions.

Development of Neonatal Respiratory and Intensive Care: Chinese Perspectives

“…CPAP-treated infants had a 90% survival rate. In those treated with conventional and high-frequency ventilation, 70% recovered or were discharged, which was similar to the results of the nationwide and Hebei network studies [9,12] . This province is located in mid-southern China, with a population of 69 million and 780,000 births in 2009.…”

“…The mortality rate of NRF varied across the regions by up to 7-fold. The male-tofemale ratio of NRF was 2.6: 1, and more male infants received surfactant than females [12] . Surfactant use in RDS in both studies achieved a nearly 15% net increment in survival ( table 1 ), demonstrating its cost-effectiveness in these NICUs in the two study periods.…”

“…The mortality and cost of NRF differed significantly between NICUs in mid-western and southeastern regions, mainly associated with the organization of perinatal care, NICU facility and staff competence, health insurance coverage and socioeconomic and cultural complexity [9][10][11] . In the third phase, during 2007-2010, we conducted several multicenter studies, either as a province-wide network or nationwide, employing interventional protocols for improvement of respiratory support and registration of NRF [12,13] .…”

“…In 2007, we conducted a clinical epidemiologic study of NRF in 14 provincial and sub-provincial NICUs in Hebei province [12] using the same study protocol [9] . This province was in the mid-range of economic development, representative of ten provinces in northern and mid-eastern China.…”

A Case Series of 130 Neonates with Congenital Syphilis: Preterm Neonates Had More Clinical Evidences of Infection than Term Neonates

“…Withdrawal of care for severely ill infants was also referred by other study from China [14]; the main reasons for it included unaffordable cost and the high prevalence of co-morbidities and possible long term neurodevelopment impairments.…”