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Cao Y, Jiang S, Sun J, et al. Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China. JAMA Netw Open. 2021;4(8):e2118904doi: 10.1001/jamanetworkopen.2021.18904.
Cao, Y., Jiang, S., Sun, J., Hei, M., Wang, L., Zhang, H., Ma, X., Wu, H., Li, X., Sun, H., Zhou, W., Shi, Y., Wang, Y., Gu, X., Yang, T., Lu, Y., Du, L., Chen, C., Lee, S. K., Zhou, W. (2021). Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China. JAMA network open, 4(8), e2118904. https://doi.org/10.1001/jamanetworkopen.2021.18904
Cao, Yun, et al. "Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China." JAMA network open vol. 4,8 (2021): e2118904. doi: https://doi.org/10.1001/jamanetworkopen.2021.18904
Cao Y, Jiang S, Sun J, Hei M, Wang L, Zhang H, Ma X, Wu H, Li X, Sun H, Zhou W, Shi Y, Wang Y, Gu X, Yang T, Lu Y, Du L, Chen C, Lee SK, Zhou W. Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China. JAMA Netw Open. 2021 Aug 02;4(8):e2118904. doi: 10.1001/jamanetworkopen.2021.18904. PMID: 34338792; PMCID: PMC8329742.
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JAMA Netw Open. 2021 Aug 02;4(8):e2118904. doi: 10.1001/jamanetworkopen.2021.18904.

Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China.

JAMA network open

Yun Cao, Siyuan Jiang, Jianhua Sun, Mingyan Hei, Laishuan Wang, Huayan Zhang, Xiaolu Ma, Hui Wu, Xiaoying Li, Huiqing Sun, Wei Zhou, Yuan Shi, Yanchen Wang, Xinyue Gu, Tongling Yang, Yulan Lu, Lizhong Du, Chao Chen, Shoo K Lee, Wenhao Zhou,

Affiliations

  1. Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
  2. Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  3. Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.
  4. Division of Neonatology, Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangdong, China.
  5. Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia.
  6. Division of Neonatology, The Children's Hospital Zhejiang University School of Medicine, Zhejiang, China.
  7. Division of Neonatology, The First Bethune Hospital of Jilin University, Jilin, China.
  8. Division of Neonatology, Qilu Children's Hospital of Shandong University, Shandong, China.
  9. Division of Neonatology, Children's Hospital Affiliated with Zhengzhou University, Children's Hospital of Henan Zhengzhou, Hennan, China.
  10. Division of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.
  11. NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China.
  12. Center for Molecular Medicine, Pediatrics Research Institute, Children's Hospital of Fudan University, Shanghai, China.
  13. Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
  14. Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
  15. Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

PMID: 34338792 PMCID: PMC8329742 DOI: 10.1001/jamanetworkopen.2021.18904

Abstract

IMPORTANCE: The Chinese Neonatal Network was established in 2018 and maintains a standardized national clinical database of very preterm or very low-birth-weight infants in tertiary neonatal intensive care units (NICUs) throughout China. National-level data on outcomes and care practices of very preterm infants (VPIs) in China are lacking.

OBJECTIVE: To assess the care practices in NICUs and outcomes among VPIs in China.

DESIGN, SETTING, AND PARTICIPANTS: A cohort study was conducted comprising 57 tertiary hospitals from 25 provinces throughout China. All infants with gestational age (GA) less than 32 weeks who were admitted to the 57 NICUs between January 1 and December 31, 2019, were included.

MAIN OUTCOMES AND MEASURES: Care practices, morbidities, and survival were the primary outcomes of the study. Major morbidities included bronchopulmonary dysplasia, severe intraventricular hemorrhage (grade ≥3) and/or periventricular leukomalacia, necrotizing enterocolitis (stage ≥2), sepsis, and severe retinopathy of prematurity (stage ≥3).

RESULTS: A total of 9552 VPIs were included, with mean (SD) GA of 29.5 (1.7) weeks and mean (SD) birth weight of 1321 (321) g; 5404 infants (56.6%) were male. Antenatal corticosteroids were used in 75.6% (6505 of 8601) of VPIs, and 54.8% (5211 of 9503)were born through cesarean delivery. In the delivery room, 12.1% of VPIs received continuous positive airway pressure and 26.7% (2378 or 8923) were intubated. Surfactant was prescribed for 52.7% of the infants, and postnatal dexamethasone was prescribed to 9.5% (636 of 6675) of the infants. A total of 85.5% (8171) of the infants received complete care, and 14.5% (1381) were discharged against medical advice. The incidences of the major morbidities were bronchopulmonary dysplasia, 29.2% (2379 of 8148); severe intraventricular hemorrhage and/or periventricular leukomalacia, 10.4% (745 of 7189); necrotizing enterocolitis, 4.9% (403 of 8171 ); sepsis, 9.4% (764 of 8171); and severe retinopathy of prematurity, 4.3% (296 of 6851) among infants who received complete care. Among VPIs with complete care, 95.4% (7792 of 8171) survived: 65.6% (155 of 236) at 25 weeks' or less GA, 89.0% (880 of 988) at 26 to 27 weeks' GA, 94.9% (2635 of 2755)at 28 to 29 weeks' GA, and 98.3% (4122 of 4192) at 30 to 31 weeks' GA. Only 57.2% (4677 of 8171) of infants survived without major morbidity: 10.5% (25 of 236) at 25 weeks' or less GA, 26.8% (48 of 179) at 26 to 27 weeks' GA, 51.1% (1409 of 2755) at 28 to 29 weeks' GA, and 69.3% (2904 of 4192) at 30 to 31 weeks' GA. Among all infants admitted, the survival rate was 87.6% (8370 of 9552)and survival without major morbidities was 51.8% (4947 of 9552).

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that survival and survival without major morbidity of VPIs in Chinese NICUs have improved but remain lower than in high-income countries. Comprehensive and targeted quality improvement efforts are needed to provide complete care for all VPIs, optimize obstetrical and neonatal care practices, and improve outcomes.

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