Outcomes at discharge of preterm infants born <34 weeks' gestation.

Ning Xin Luo; Si Yuan Jiang; Yun Cao; Shu Jun LI; Jun Yan Han; Qi Zhou; Meng Meng LI; Jin Zhen Guo; Hong Yan Liu; Zu Ming Yang; Yong JI; Bao Quan Zhang; Zhi Feng Huang; Jing Yuan; Dan Dan Pan; Jing Yun Shi; Xue Feng HU; Su Lin; Qian Zhao; Chang Hong Yan; Le Wang; Qiu Fen Wei; Qing Kan; Jin Zhi Gao; Cui Qing Liu; Shan Yu Jiang; Xiang Hong Liu; Hui Qing Sun; Juan DU; Li HE

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Outcomes at discharge of preterm infants born <34 weeks' gestation.

VernacularTitle:出生胎龄<34周住院早产儿出院预后分析
Author: Ning Xin LUO ¹ ; Si Yuan JIANG ¹ ; Yun CAO ¹ ; Shu Jun LI ¹ ; Jun Yan HAN ² ; Qi ZHOU ¹ ; Meng Meng LI ³ ; Jin Zhen GUO ⁴ ; Hong Yan LIU ⁵ ; Zu Ming YANG ⁶ ; Yong JI ⁷ ; Bao Quan ZHANG ⁸ ; Zhi Feng HUANG ⁹ ; Jing YUAN ¹⁰ ; Dan Dan PAN ¹¹ ; Jing Yun SHI ¹² ; Xue Feng HU ¹³ ; Su LIN ¹⁴ ; Qian ZHAO ¹⁵ ; Chang Hong YAN ¹⁶ ; Le WANG ¹⁷ ; Qiu Fen WEI ¹⁸ ; Qing KAN ¹⁹ ; Jin Zhi GAO ²⁰ ; Cui Qing LIU ²¹ ; Shan Yu JIANG ²² ; Xiang Hong LIU ²³ ; Hui Qing SUN ²⁴ ; Juan DU ²⁵ ; Li HE ²⁶
Author Information

1. Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
2. National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
3. Department of Neonatology, Women's Hospital of Nanjing Medical University, Nanjing 210004, China.
4. Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an 200001, China.
5. Department of Neonatology, Maternal and Child Hospital of Hubei Province, Wuhan 430064, China.
6. Department of Neonatology, Suzhou Municipal Hospital, Suzhou 215008, China.
7. Department of Neonatology, Shanxi Children's Hospital, Taiyuan 030006, China.
8. Department of Neonatology, Fujian Maternity and Child Health Hospital, Fuzhou 350005, China.
9. Department of Neonatology, the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University, Shenzhen 518047, China.
10. Department of Neonatology, Qingdao Women and Children's Hospital of Southern Medical University, Qingdao 266011, China.
11. Department of Neonatology, Guiyang Maternal and Child Health Care Hospital, Guiyong Children's Hospital, Guiyang 550002, China.
12. Department of Neonatology, Gansu Provincial Maternal and Child-care Hospital, Lanzhou 730050, China.
13. Department of Neonatology, Shanghai First Maternal and Infant Hospital, Shanghai 201204, China.
14. Department of Neonatology, the 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325088, China.
15. Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
16. Department of Neonatology, Jiangxi Provincial Children's Hospital, Nanchang 330006, China.
17. Department of Neonatology, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, China.
18. Department of Neonatology, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning 530002, China.
19. Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
20. Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China.
21. Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang 050031, China.
22. Department of Neonatology, Wuxi Maternal and Child Health Care Hospital, Wuxi 214002, China.
23. Department of Neonatology, Children's Hospital Affiliated to Shandong University, Jinan 250022, China.
24. Division of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Jinan Children's Hospital, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
25. Department of Neonatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
26. Department of Neonatology, the Third Xiangya Hospital of Central South University, Changsha 410013, China.
Collective Name:Reduction of Infection in Chinese Neonatal Intensive Care Units Using the Evidence-based Practice for Improving Quality
Publication Type:Randomized Controlled Trial
MeSH: Bronchopulmonary Dysplasia/epidemiology*; Gestational Age; Humans; Infant; Infant Mortality/trends*; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases/epidemiology*; Patient Discharge; Retinopathy of Prematurity/epidemiology*; Sepsis/epidemiology*
From: Chinese Journal of Pediatrics 2022;60(8):774-780
CountryChina
Language:Chinese
Abstract: Objective: To investigate the incidence and trend of short-term outcomes among preterm infants born <34 weeks' gestation. Methods: A secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study "reduction of infection in neonatal intensive care units (NICU) using the evidence-based practice for improving quality (REIN-EPIQ) study". This study was conducted in 25 tertiary NICU. A total of 27 192 infants with gestational age <34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled. Infants with severe congenital malformation were excluded. Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups. Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years. Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders. Results: A total of 27 192 preterm infants were enrolled with gestational age of (31.3±2.0) weeks at birth and weight of (1 617±415) g at birth. Overall, 9.5% (2 594/27 192) of infants were discharged against medical advice, and the overall mortality rate was 10.7% (2 907/27 192). Mortality for infants who received complete care was 4.7% (1 147/24 598), and mortality or any major morbidity was 26.2% (6 452/24 598). The incidences of moderate to severe bronchopulmonary dysplasia, sepsis, severe intraventricular hemorrhage or periventricular leukomalacia, proven necrotizing enterocolitis, and severe retinopathy of prematurity were 16.0% (4 342/27 192), 11.9% (3 225/27 192), 6.8% (1 641/24 206), 3.6% (939/25 762) and 1.5% (214/13 868), respectively. There was a decreasing of the overall mortality (P<0.001) during the 3 years. Also, the incidences for sepsis and severe retinopathy of prematurity both decreased (both P<0.001). However, there were no significant differences in the major morbidity in preterm infants who received complete care during the 3-year study period (P=0.230). After adjusting for confounders, infants admitted during the third study year showed significantly lower risk of overall mortality (adjust OR=0.62, 95%CI 0.55-0.69, P<0.001), mortality or major morbidity, moderate to severe bronchopulmonary dysplasia, sepsis and severe retinopathy of prematurity, compared to those admitted in the first study year (all P<0.05). Conclusions: From 2015 to 2018, the mortality and major morbidities among preterm infants in Chinese NICU decreased, but there is still space for further efforts. Further targeted quality improvement is needed to improve the overall outcome of preterm infants.