OBJECTIVES: To study the treatment outcomes of extremely preterm infants. METHODS: A retrospective analysis was performed for the clinical data of extremely preterm infants who were admitted to the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University from January 2016 to December 2022. The infants were divided into a non-in-hospital death group and a survival group. SPSS 29.0 was used for data analysis. RESULTS: A total of 422 extremely preterm infants were included, of which 155 were in the non-in-hospital death group and 267 in the survival group. The gestational age, birth weight, cesarean section rate, and proportion of mothers with premature rupture of membranes >18 hours in the non-in-hospital death group were all lower than those in the survival group (P<0.05). In contrast, the proportions of Apgar score ≤3 at 1 minute, intubation, neonatal respiratory distress syndrome, early-onset sepsis, periventricular-intraventricular hemorrhage (grades III-IV), and pneumorrhagia were higher in the non-in-hospital death group compared to the survival group (P<0.05). CONCLUSIONS Low gestational age, low birth weight, the history of birth asphyxia, severe intracranial hemorrhage, and pneumorrhagia may be the main causes of non-in-hospital death in extremely preterm infants, and therefore, perinatal health care should be enhanced to reduce the onset of asphyxia and severe diseases.
Humans ; Infant, Extremely Premature ; Infant, Newborn ; Female ; Retrospective Studies ; Male ; Treatment Outcome ; Gestational Age ; Apgar Score ; Birth Weight ; Respiratory Distress Syndrome, Newborn/mortality*

OBJECTIVES: To provide reference basis for reducing the mortality for children under 5 years old and promote the healthy development, the mortality for children under 5 years old and the main causes for death in Liuyang City from 2013 to 2020 are analyzed. METHODS: The data of 725 cases of death for children under 5 years old in Liuyang City from 2013 to 2020 were collected.The causes and difference of death among the children were analyzed retrospectively by descriptive statistic methods. RESULTS: There were a total of 144 516 live births in Liuyang City from 2013 to 2020. The mortality for children under 5 years old was 5.01‰, for infants was 3.39‰, and for newborns was 1.63‰. The male child mortality was 5.28‰, and the female child mortality rate was 4.72‰, with significant difference (P>0.05). The mortality for children under 5 years old was seasonal fluctuation, without significant difference among seasons (P>0.05). For the past 5 years, the top 3 causes for death among children under 5 years old were preterm birth and low birth weight, congenital heart disease, and pneumonia. Before death, 341 cases (47.04%) were treated in provincial hospitals, 198 cases (27.31%) in county-level hospitals, 56 cases (7.72%) in village-level hospitals, and 130 cases (17.93%) were not treated. CONCLUSIONS The mortality for children under 5 years old in Liuyang City is gradually reduced in the past 5 years. The main causes for death are premature birth and low birth weight, congenital heart disease and pneumonia. We should develop healthy education, improve the rate of prenatal diagnosis, promote the construction of obstetrics and paediatrics, and fundamentally reduce the mortality for children under 5 years old.
Cause of Death ; Child ; Child Mortality ; Child, Preschool ; Female ; Heart Defects, Congenital ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Male ; Pneumonia/epidemiology* ; Pregnancy ; Premature Birth ; Retrospective Studies

PURPOSE: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. METHODS: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. RESULTS: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P < 0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4–1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3–1,628.7) and decreased activity (OR, 34; 95% CI, 1.8–633.4), were found to be associated with fatality. CONCLUSION: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.
Birth Weight ; Escherichia coli ; Gestational Age ; Gram-Negative Bacterial Infections ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal* ; Medical Records ; Mortality ; Neutropenia ; Prognosis ; Retrospective Studies ; Sepsis* ; Streptococcus

PURPOSE: Despite the increasing use of continuous renal replacement therapy (CRRT) in the neonatal intensive care unit (NICU), few studies have investigated its use in preterm infants. This study evaluated the prognosis of preterm infants after CRRT and identified risk factors of mortality after CRRT. MATERIALS AND METHODS: A retrospective review was performed in 33 preterm infants who underwent CRRT at the NICU of Samsung Medical Center between 2008 and 2017. Data of the demographic characteristics, predisposing morbidity, cardiopulmonary function, and CRRT were collected and compared between surviving and non-surviving preterm infants treated with CRRT. Univariable and multivariable analyses were performed to identify factors affecting mortality. RESULTS: Compared with the survivors, the non-survivors showed younger gestational age (29.3 vs. 33.6 weeks), lower birth weight (1359 vs. 2174 g), and lower Apgar scores at 1 minute (4.4 vs. 6.6) and 5 minutes (6.5 vs. 8.6). At the initiation of CRRT, the non-survivors showed a higher incidence of inotropic use (93% vs. 40%, p=0.017) and fluid overload (16.8% vs. 4.0%, p=0.031). Multivariable analysis revealed that fluid overload >10% at CRRT initiation was the primary determinant of mortality after CRRT in premature infants, with an adjusted odds ratio of 14.6 and a 95% confidence interval of 1.10–211.29. CONCLUSION: Our data suggest that the degree of immaturity, cardiopulmonary instability, and fluid overload affect the prognosis of preterm infants after CRRT. Preventing fluid overload and earlier initiation of CRRT may improve treatment outcomes.
Birth Weight ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Mortality ; Odds Ratio ; Prognosis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survivors

BACKGROUND: This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. METHODS: Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. RESULTS: The survival rate of all VLBWIs and of infants with GA 22–23, 24–25, 26–27, 28–29, 30–32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22–23, 24–25, 26–27, 28–29, 30–32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22–23, 24–25, 26–27, 28–29, 30–32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24–27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. CONCLUSION: Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22–27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.
Bronchopulmonary Dysplasia ; Gestational Age ; Hemorrhage ; Humans ; Infant Mortality ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Korea ; Quality Improvement ; Survival Rate

BACKGROUND: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C–37.5°C. PURPOSE: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. METHODS: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. RESULTS: The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C–37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04–1.83), 1.44 (95% CI, 1.05–1.97) and 1.86 (95% CI, 1.22–2.82) for infants with admission temperatures of 36.0°C–36.4°C, 35.0°C–35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. CONCLUSION: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.
Apgar Score ; Birth Weight ; Body Temperature ; Bronchopulmonary Dysplasia ; Cohort Studies ; Delivery Rooms ; Hemorrhage ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Hypothermia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intubation ; Korea ; Laser Therapy ; Mortality ; Parturition ; Pregnancy ; Prospective Studies ; Retinopathy of Prematurity ; Seizures ; Sepsis

Hemodynamically significant preterm patent ductus arteriosus (PDA) affects mortality; comorbidities such as necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia; and adverse long-term neurodevelopmental outcomes in preterm infants, particularly in very low birth weight infants. However, recent studies have indicated that there is no consensus on the causal relationship between PDA and neonatal outcomes, the benefit of PDA treatment, the factors guiding the need for treatment, and optimal treatment strategies. Such uncertainty has resulted in wide variations in practice for treating preterm PDA between units, regions, and nations. Nowadays, there has been a paradigm shift to more conservative treatment for preterm PDA, and suggestions regarding selective management of preterm PDA considering risk factors and hemodynamic significance are increasing. Neonatologist-performed echocardiography and advances in modalities to assess hemodynamic significance such as biologic markers and near-infrared spectroscopy also help improve the efficacy of selective treatment of preterm PDA.
Biomarkers ; Bronchopulmonary Dysplasia ; Comorbidity ; Consensus ; Ductus Arteriosus, Patent ; Echocardiography ; Enterocolitis, Necrotizing ; Hemodynamics ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Mortality ; Risk Factors ; Spectroscopy, Near-Infrared ; Treatment Outcome ; Uncertainty

PURPOSE: This study aimed to investigate the incidence and clinical features of late-onset circulatory collapse (LCC) in preterm infants. METHODS: Medical records of 327 preterm infants (born before 32 gestational weeks) admitted to the neonatal intensive care unit of Seoul National University Bundang Hospital between January 2014 and December 2017 were reviewed. LCC was defined as sudden onset of refractory hypotension occurring after 7 days of life without obvious causes, which responded to glucocorticoid administration. Clinical characteristics and outcomes in infants with LCC were compared with those in infants with hypotension associated with identifiable causes, which developed after 7 days of life. RESULTS: Among 327 preterm infants who enrolled in this study, 65 infants developed hypotension with oliguria after 7 days of life. Among these 65 infants, 35 (53.8%) met the criteria for LCC and 30 (46.2%) were diagnosed with hypotension associated with other identifiable causes. No statistically significant differences were observed in the baseline pre- and perinatal characteristics between infants with LCC and those with hypotension associated with other causes. Infants with hypotension associated with other causes showed a higher mortality rate than those with LCC (33.3% vs. 5.7%, P=0.004). The mean gestational age and birth weight of infants with LCC were 27+5±2+1 weeks and 963±245 g, respectively. LCC occurred at a mean postnatal age of 18 days. The median body weight at the time of diagnosis of LCC was 1,200 g. No association was observed between LCC and gestational age. CONCLUSION: Among preterm infants born before 32 gestastional weeks who developed hypotension after 7 days of life, nearly 50% were diagnosed with LCC without apparent identifiable causes. Infants with LCC showed a lower mortality rate than those with hypotension associated with other causes.
Birth Weight ; Body Weight ; Diagnosis ; Gestational Age ; Humans ; Hydrocortisone ; Hypotension ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Medical Records ; Mortality ; Oliguria ; Seoul ; Shock

PURPOSE: Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. METHODS: This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28–34 weeks and birth weight of 1,000–1,800 g. RESULTS: Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12–0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99–1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). CONCLUSION: The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.
Birth Weight ; Diarrhea ; Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Lactobacillus reuteri ; Lactobacillus ; Length of Stay ; Mortality ; Parenteral Nutrition ; Prevalence ; Probiotics ; Sepsis

PURPOSE: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. METHODS: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight < 1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. RESULTS: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9–34.3 weeks) and 893 g (range, 610–1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3–11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1–6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1–14 days) after the procedure. CONCLUSION: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.
Birth Weight ; Diatrizoate Meglumine ; Enema ; Enterocolitis, Necrotizing ; Fluoroscopy ; Gestational Age ; Glycerol ; Humans ; Ileocecal Valve ; Ileus ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Meconium ; Mortality ; Ultrasonography