Outcomes and care practices of extremely preterm infants at 22-25 weeks' gestation age from the Chinese Neonatal Network.
10.3760/cma.j.cn112140-20231017-00296
- Author:
Si Yuan JIANG
1
;
Chuan Zhong YANG
2
;
Xiu Ying TIAN
3
;
Dong Mei CHEN
4
;
Zu Ming YANG
5
;
Jing Yun SHI
6
;
Fa Lin XU
7
;
Yan MO
8
;
Xin Yue GU
9
;
Shoo K LEE
10
;
Wen Hao ZHOU
11
;
Yun CAO
1
Author Information
1. Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
2. Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China.
3. Department of Neonatology, Nankai University Maternity Hospital, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin 300199,China.
4. Department of Neonatology, Quanzhou Women's and Children's Hospital, Quanzhou 362017,China.
5. Department of Neonatology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215001,China.
6. Department of Neonatology, Gansu Provincial Central Hospital, Gansu Provincial Maternity and Child Care Hospital, Lanzhou 730050, China.
7. Department of Pediatrics, the Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou 450052, China.
8. Neonatal Medical Center, the Children's Hospital of Guangxi Zhuang Autonomous Region, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning 530005, China.
9. National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
10. the Maternal Infant Care Research Center (MiCARE), Mount Sinai Hospital, Toronto M5G 1X5, Canada.
11. Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China.
- Publication Type:Journal Article
- MeSH:
Infant;
Infant, Newborn;
Male;
Humans;
Female;
Pregnancy;
Infant, Extremely Premature;
Gestational Age;
Magnesium Sulfate/therapeutic use*;
Cross-Sectional Studies;
Infant, Premature, Diseases/epidemiology*;
Infant, Newborn, Diseases;
Steroids;
Intensive Care Units, Neonatal;
China/epidemiology*
- From:
Chinese Journal of Pediatrics
2024;62(1):22-28
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To describe the current status and trends in the outcomes and care practices of extremely preterm infants at 22-25 weeks' gestation age from the Chinese Neonatal Network (CHNN) from 2019 to 2021. Methods: This cross-sectional study used data from the CHNN cohort of very preterm infants. All 963 extremely preterm infants with gestational age between 22-25 weeks who were admitted to neonatal intensive care units (NICU) of the CHNN from 2019 to 2021 were included. Infants admitted after 24 hours of life or transferred to non-CHNN hospitals were excluded. Perinatal care practices, survival rates, incidences of major morbidities, and NICU treatments were described according to different gestational age groups and admission years. Comparison among gestational age groups was conducted using χ2 and Kruskal-Wallis tests. Trends by year were evaluated by Cochran-Armitage and Jonckheere-Terpstra tests for trend. Results: Of the 963 extremely preterm infants enrolled, 588 extremely preterm infants (61.1%) were male. The gestational age was 25.0 (24.4, 25.6) weeks, with 29 extremely preterm infants (3.0%), 88 extremely preterm infants (9.1%), 264 extremely preterm infants (27.4%), and 582 extremely preterm infants (60.4%) at 22, 23, 24, and 25 weeks of gestation age, respectively. The birth weight was 770 (680, 840) g. From 2019 to 2021, the number of extremely preterm infants increased each year (285, 312, and 366 extremely preterm infants, respectively). Antenatal steroids and magnesium sulfate were administered to 67.7% (615/908) and 51.1% (453/886) mothers of extremely preterm infants. In the delivery room, 20.8% (200/963) and 69.5% (669/963) extremely preterm infants received noninvasive positive end-expiratory pressure support and endotracheal intubation. Delayed cord clamping and cord milking were performed in 19.0% (149/784) and 30.4% (241/794) extremely preterm infants. From 2019 to 2021, there were significant increases in the usage of antenatal steroids, antenatal magnesium sulfate, and delivery room noninvasive positive-end expiratory pressure support (all P<0.05). Overall, 349 extremely preterm infants (36.2%) did not receive complete care, 392 extremely preterm infants (40.7%) received complete care and survived to discharge, and 222 extremely preterm infants (23.1%) received complete care but died in hospital. The survival rates for extremely preterm infants at 22, 23, 24 and 25 weeks of gestation age were 10.3% (3/29), 23.9% (21/88), 33.0% (87/264) and 48.3% (281/582), respectively. From 2019 to 2021, there were no statistically significant trends in complete care, survival, and mortality rates (all P>0.05). Only 11.5% (45/392) extremely preterm infants survived without major morbidities. Moderate to severe bronchopulmonary dysplasia (67.3% (264/392)) and severe retinopathy of prematurity (61.5% (241/392)) were the most common morbidities among survivors. The incidences of severe intraventricular hemorrhage or periventricular leukomalacia, necrotizing enterocolitis, and sepsis were 15.3% (60/392), 5.9% (23/392) and 19.1% (75/392), respectively. Overall, 83.7% (328/392) survivors received invasive ventilation during hospitalization, with a duration of 22 (10, 42) days. The hospital stay for survivors was 97 (86, 116) days. Conclusions: With the increasing number of extremely preterm infants at 22-25 weeks' gestation admitted to CHNN NICU, the survival rate remained low, especially the rate of survival without major morbidities. Further quality improvement initiatives are needed to facilitate the implementation of evidence-based care practices.
