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.
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*

OBJECTIVETo investigate the birth state of neonates and the disease spectrum of hospitalized neonates from a primary hospital, and compare with the national data of the same period.

METHODSA retrospective investigation was carried out in 1,434 neonates born or hospitalized in this hospital from January 2005 to December 2005.

RESULTSDuring the investigation period, there were 1,100 neonates born in the department of obstetrics. The incidence of premature birth was 2.3%. The caesarean birth accounted for 54.2%, significantly higher than the national average (49.2%, p<0.01). The neonatal mortality was 0.2%. The incidences of antepartum hemorrhage, threatened abortion, and pregnancy infection in preterm infant' s mothers were significantly higher than those in full-term infant' s mothers. A total of 344 neonates were admitted to the department of pediatrics during the investigation period. Preterm infants accounted for 38.0% which was higher than the national average (26.2%; p<0.01). Beside preterm infants, asphyxia, respiratory distress syndrome (RDS), sepsis and intracranial hemorrhage were shown to have a significantly higher proportion than the national averages. The mortality of hospitalized neonates was 0.9%.

CONCLUSIONSThe higher cesarean section rate should be controlled in our hospital. Prenatal health care and fetal monitoring should be strengthened to decrease the incidence of premature birth, RDS, sepsis and intracranial hemorrhage, thus reducing the mortality of neonates.

Adult ; Cesarean Section ; Female ; Hospitalization ; Humans ; Incidence ; Infant Mortality ; Infant, Newborn ; Infant, Premature, Diseases ; epidemiology ; Pregnancy ; Pregnancy Complications ; epidemiology ; Premature Birth ; epidemiology ; Retrospective Studies

PURPOSE: It is to examine clinical manifestations, early biochemical indicators, and risk factors for non-oliguric hyperkalemia (NOHK) in extremely low birth weight infants (ELBWI). MATERIALS AND METHODS: We collected clinical and biochemical data from 75 ELBWI admitted to Ajou University Hospital between Jan. 2008 and Jun. 2011 by reviewing medical records retrospectively. NOHK was defined as serum potassium > or =7 mmol/L during the first 72 hours of life with urine output > or =1 mL/kg/h. RESULTS: NOHK developed in 26.7% (20/75) of ELBWI. Among NOHK developed in ELBWI, 85% (17/20) developed within postnatal (PN) 48 hours, 5% (1/20) experienced cardiac arrhythmia and 20% (4/20) of NOHK infants expired within PN 72 hours. There were statistically significant differences in gestational age, use of antenatal steroid, and serum phosphorous level at PN 24 hours, and serum sodium, calcium, and urea levels at PN 72 hours between NOHK and non-NOHK groups (p-value <0.050). However, there were no statistical differences in the rate of intraventricular hemorrhage, arrhythmia, mortality occurred, methods of fluid therapy, supplementation of amino acid and calcium, frequencies of umbilical artery catheterization and urine output between the two groups. CONCLUSION: NOHK is not a rare complication in ELBWI. It occurs more frequently in ELBWI with younger gestational age and who didn't use antenatal steroid. Furthermore, electrolyte imbalance such as hypernatremia, hypocalcemia and hyperphosphatemia occurred more often in NOHK group within PN 72 hours. Therefore, more use of antenatal steroid and careful control by monitoring electrolyte imbalance should be considered in order to prevent NOHK in ELBWI.
Gestational Age ; Humans ; Hyperkalemia/diagnosis/drug therapy/*epidemiology ; *Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/diagnosis/drug therapy/*epidemiology ; Republic of Korea ; Risk Factors

OBJECTIVETo understand the distribution of birth weight among premature infants and the associated social factors.

METHODSThe study population consisted of 97 537 women who delivered singleton live birth of 20 to 41 gestational weeks in 4 counties/cities, Jiangsu and Zhejiang provinces, China from 1995 to 2000. Chi-square test was employed to test the difference of proportions between respective groups. One- way ANOVA was used to test the differences regarding the mean of gestational weeks at the first prenatal visit and the mean of prenatal visits between the two groups. Multivariate logistic regression was conducted to examine the factors associated with premature birth.

RESULTSWomen aged 35 years had higher (8.8%) premature incidence than those aged less than 24 years (5.6%), 25 - 29 years (4.6%), or 30 - 34 years (4.5%, P < 0.001). Women with height less than 149 cm had higher (6.8%) premature incidence than those with height taller than 150 cm (5.0%). Women whose BMI were at least 28 and 24 - 28 had higher (5.5%, 5.5%) premature incidences than those whose BMI were 18.5 - 24.0 (5.0%), < 18.5 (4.6%, P < 0.001). The incidence of premature birth was 6.0% among women without previous pregnancy, higher than that among those women with 4 times of pregnancies (5.7%), 2 times of pregnancies (4.3%), and 3 times of pregnancies (4.0%). Parous women with at least two deliveries had higher (9.3%) premature incidence than the primiparous women (5.2%) and whose women with only one delivery (4.5%, P < 0.001). Women who received early prenatal care had lower 4.7% premature incidence than those who did not receive the service (6.1%). The mean times of prenatal visits among women with premature births was 8.53, less than that of those with full term delivery (10.97). Women with less than four times of prenatal visit had higher (18.9%) premature incidence than those with at least five prenatal visits (4.9%). Multivariate logistic regression showed that premature delivery risk was associated with age, height, BMI, gravidity, parity, early prenatal care, the mean of gestational weeks at first prenatal visit and the mean number of prenatal visits etc.

CONCLUSIONPremature delivery risk was associated with factors as age, height, BMI, gravidity, parity, early prenatal care, the mean of gestational weeks at first prenatal visit, the mean number of prenatal visits etc.

Adult ; Birth Weight ; China ; epidemiology ; Female ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; epidemiology ; Pregnancy ; Risk Factors ; Socioeconomic Factors

OBJECTIVETo study the birth rate, mortality, complications, related factors of preterm infants at Beijing Haidian Maternity and Children's Hospital in 2007, so as to establish the foundations for a more systematic and effective program for clinical treatments.

METHODSData of all the neonates born at Beijing Haidian Maternity and Children's Hospital during the period from January 1, 2007 to December 31, 2007 were recorded for statistical analysis. All near-term infants of 35 - 37 weeks of gestational age were taken into observation group. Within 24 hours after birth, blood routine examination, urine and stool routine examination, blood gas analysis and electrolytes, blood glucose monitoring (at 1st, 3rd, 6th, 12th, and 24th hours), chest radiography examination, skull and heart color Doppler ultrasonographic examination were conducted. Full-term infants who were born on the first day of every month were randomly selected as a comparison group (totally 350 cases) for statistical analysis. Complications of the two groups were recorded in detail. Factors such as the ages of parturients, maternal infections, pregnancy-induced hypertension, diabetes, anaemia, premature rupture of membranes, abnormal aminotic fluid, abnormal umbilical cord, abnormal placenta, and twin were analyzed and compared.

RESULTSOf the 12,286 infants born during the study period, 333 were late-preterm infants; the birth rate of late-preterm infants was 2.71%. Among the complications in late-preterm infants, the hyperbilirubinemia topped at 33.6%, followed by respiratory distress (16.8%), hypoglycemia (9.0%), intracranial hemorrhage (8.1%), anemia or erythrocytosis (5.7%), and digestive system disease (5.4%). Late-preterm infants have higher rate of the hyperbilirubinemia, respiratory distress, hypoglycemia, anemia or erythrocytosis and digestive system disease (P < 0.05). The length of hospital stay of late-preterm infants, which is 5.1 d +/- 3.90 d, was significantly longer than those of full-term infants which was 3.2 d +/- 1.61 d (P < 0.05).

CONCLUSIONThe proportion of late-preterm infants was 2.71% of all live born infants at Beijing Haidian Maternity and Children's Hospital from January 1, 2007 to December 31, 2007. The occurrence rate of complications and mortality rate were higher than those of full-term infants. Late-preterm infants also have longer hospital stay. Hyperbilirubinemia is a common complication for late-preterm infants. Pregnancy-induced hypertension, anemia, premature rupture of membranes and twins are the major causes of higher morbidity and mortality of late-preterm infants. Pediatricians should pay much more attention to late-preterm infants, and should accept them for further observation and treatments.

Birth Rate ; China ; epidemiology ; Female ; Health Status ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; epidemiology ; Male ; Prospective Studies

OBJECTIVETo evaluate the clinical features of respiratory diseases of late preterm neonates.

METHODSSix hundred and thirty late preterm infant(gestational age: 34~36+6weeks),4401 cases of term infants and 328 early preterm infants who were born at the obstetrical department of Peking University 3rd Hospital from January 2009 to December 2010 were enrolled. Among them 84 late preterm infants, 135 term infants and 182 early preterm infants developed respiratory diseases. The incidence of respiratory diseases,clinical features and the severity of the diseases were compared among the three groups.

RESULTSThe incidence and mortality rates of respiratory diseases and the percentage of severe cases were significantly higher in the late preterm group than in the term group, but lower than in the early preterm group (P<0.01). The symptoms of respiratory disease occurred earlier in the late preterm group than in the term group, but later than in the early preterm group (P<0.01). The late preterm group had a significantly higher incidence of tachypnea and lower incidence of retraction sign when compared with the term and early preterm groups (P<0.05). The percentages requiring oxygen therapy and mechanical ventilation in the late preterm group were both significantly higher than in the term group, but lower than in the early preterm group (P<0.05). The multiple linear regression analysis showed 11 factors associated with the severity of respiratory diseases: decreased arterial partial pressure of oxygen, hematokrit, pH value and respiratory rate, arterial oxyhemoglobin saturation, systolic arterial pressure, 5 minute Apgar score and gestational age, and increased blood urea nitrogen, heart rate and respiratory rate.

CONCLUSIONSLate preterm infants are more likely to develop respiratory diseases than term infants, and to develop a more severe condition and need a more intensive respiratory support treatment. Tachypnea is a common presentation of dyspnea in late preterm infants and occurs earlier than in term infants but later than in early preterm infants. It may usually indicate a serious condition when dyspnea, abnormal heart rate and blood pressure, and multisystem damages occur in late preterm infants.

Humans ; Incidence ; Infant, Newborn ; Infant, Premature, Diseases ; epidemiology ; mortality ; Prognosis ; Respiratory Tract Diseases ; epidemiology ; mortality ; Retrospective Studies

Cerebral Hemorrhage ; epidemiology ; etiology ; prevention & control ; Cerebral Ventricles ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; epidemiology ; etiology ; prevention & control

To determine the validity of a repeat thyroid function test for preterm infants, and to investigate factors that influence thyroid function of preterm infants, thyroid functions of 105 infants born at <32 weeks' gestational age were evaluated. Initial serum free thyroxine (fT4) and thyrotropin (TSH) levels were measured during the first 10 days of life, and repeated tests were performed more than 2 weeks apart. We analyzed the effects of gestational age, systemic diseases, and nutrition on the development of thyroid dysfunction. Thirty-one infants (30%) had low fT4 levels (<0.7 ng/dL) in the absence of elevated TSH levels (<7 microU/mL). Thirteen infants (12%) had hypothyroidism (fT4 <0.7 ng/dL, TSH > or =10 microU/mL) and mean age at diagnosis was 28+/-17 days. Twelve infants had moderately elevated TSH (TSH 10-30 microU/mL) with normal fT4 levels after 1 week of postnatal life. The history of undergone surgical procedure which needed iodine containing disinfectants was significantly frequent in the infant with hypothyroidism and transient TSH elevation. Repeated thyroid function tests are necessary for preterm infants, even though they initially show normal thyroid function, and are especially important for infants who have been exposed to excessive or insufficient levels of iodine.
Female ; Gestational Age ; Humans ; Hypothyroidism/*diagnosis/epidemiology/metabolism ; Incidence ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*diagnosis/epidemiology/metabolism ; Pregnancy ; Thyroid Function Tests ; Thyrotropin/*blood ; Thyroxine/*blood

Birth Weight ; Cerebral Hemorrhage ; epidemiology ; Female ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature, Diseases ; epidemiology ; Male ; Risk Factors

Carbamoyl-Phosphate Synthase (Ammonia) ; genetics ; Enteral Nutrition ; adverse effects ; Enterocolitis, Necrotizing ; epidemiology ; etiology ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; epidemiology ; etiology ; Multivariate Analysis ; Polymorphism, Single Nucleotide ; Premature Birth ; Risk Factors ; Transfusion Reaction