Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.
Infant ; Infant, Newborn ; Humans ; Birth Weight ; Intensive Care Units, Neonatal ; Retrospective Studies ; Tertiary Care Centers ; Infant, Extremely Low Birth Weight ; Gestational Age ; Infant, Extremely Premature ; Sepsis/epidemiology* ; Retinopathy of Prematurity/epidemiology* ; Bronchopulmonary Dysplasia/epidemiology*

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*

Conflicting results on the influences of histologic chorioamnionitis (HC) on neonatal morbidities might be partly originated from using different definition of HC. The aim of this study was to determine the relationship between HC and neonatal morbidities using definition of HC that reflects the site and extent of inflammation. This was a retrospective cohort study of 261 very low birth weight (VLBW) infants admitted at a tertiary academic center. Based on the site of inflammation, HC was categorized: any HC; amnionitis; funisitis; amnionitis+funisitis. The extent of inflammation in each site was reflected by sub-defining high grade (HG). The incidences of morbidities in infants with and without HC were compared. The bronchopulmonary dysplasia (BPD) rate was significantly higher in infants with amnionitis and the severe retinopathy of prematurity (ROP) rate was significantly higher in infants with any HC and funisitis. After adjustment for both gestational age and birth weight, the respiratory distress syndrome (RDS) rate was significantly lower in infants with all categories of HC except for HG amnionitis and HG funisitis, which are not associated with lower RDS rate. HG amnionitis was significantly associated with increased BPD rate but the association of HC with severe ROP disappeared. In conclusion, HC is significantly associated with decreased RDS and HG amnionitis with increased BPD while lacking association with other neonatal morbidities in VLBW infants. The association with HC and neonatal morbidities differs by the site and extent of chorioamnionitis.
Adult ; Birth Weight ; Bronchopulmonary Dysplasia/complications/*epidemiology ; Chorioamnionitis/classification/*epidemiology/pathology ; Cohort Studies ; Female ; Gestational Age ; Humans ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Neutrophil Infiltration/immunology ; Placenta/pathology ; Pre-Eclampsia/*epidemiology/pathology ; Pregnancy ; Respiratory Distress Syndrome, Newborn/complications/*epidemiology ; Retinopathy of Prematurity/complications/*epidemiology ; Retrospective Studies ; Tertiary Care Centers

This study was conducted to describe the incidence, risk factors, and current treatment status of retinopathy of prematurity (ROP) in very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network database. Medical records of 2,009 VLBW infants born between January 2013 and June 2014 who underwent examination by an ophthalmologist were reviewed. The total incidence of ROP was 34.1%. Of the patients, 11.6% showed ROP stage > or = 3 and 11.5% received treatment of VLBW. Among all infants who received treatment of ROP, 63.6% underwent operation only; 16.9%, anti-vascular endothelial growth factor (anti-VEGF) treatment only; and 19.5%, both operation and anti-VEGF treatment. The mean gestational age (GA) and birth weight (BW) were significantly lower and the prevalence rates of respiratory distress syndrome, patent ductus arteriosus (PDA), invasive ventilator duration, and sepsis were significantly higher in the VLBW infants with ROP than in those without ROP. In the multivariable logistic regression analysis, PDA (odd ratio [OR], 2.1; 95% confidence interval [CI], 1.11-3.79) and invasive ventilator duration (OR, 1.0; 95% CI, 1.00-1.02) were significant risk factors of ROP and ROP stage > or = 3. In conclusion, the high incidence of ROP is associated with low GA and BW, and attempt to reduce the aforementioned risk factors could reduce the incidence of ROP stage > or = 3 in VLBW infants.
Antibodies/therapeutic use ; Birth Weight ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; *Infant, Very Low Birth Weight ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Retinopathy of Prematurity/drug therapy/*epidemiology/mortality ; Retrospective Studies ; Risk Factors ; Vascular Endothelial Growth Factor A/immunology

BACKGROUNDTo investigate the incidence and risk factors of retinopathy of prematurity (ROP) in two Neonatal Intensive Care Units in North and South of China, respectively.

METHODSWe studied data concerning 472 infants with gestational age (GA) ≤ 34 weeks or birth weight (BW) ≤ 2000 g who were admitted to the Zhujiang Hospital of Southern Medical University and the Fourth Hospital of Shijiazhuang between January 1, 2011 and December 31, 2011. Clinical information about perinatal neonates was collected and was confirmed by reviewing medical charts. The incidence and severity of ROP were assessed in the screened population. Main outcome measures are the incidence and severity of ROP. The relationship of clinical risk factors and the development of ROP were analyzed.

RESULTSThe overall incidence of ROP was 12.7%, and the overall incidence of type 1 ROP was 2.3%; 9.4% of infants in Zhujiang Hospital had ROP compared to 15.0% infants in the Fourth Hospital of Shijiazhuang developed ROP, and the difference is statistically significant. ROP was significantly associated with GA (odds ratio [OR]: 0.77 [0.62-0.95], P = 0.015), BW (OR: 0.998 [0.996-0.999], P = 0.008), maternal supplemental oxygen administration before and during delivery (OR: 4.27 [1.21-15.10], P = 0.024) and preeclampsia (OR: 6.07 [1.73-21.36] P = 0.005). The risk factors for ROP are different in two hospitals. In Zhujiang Hospital, BW is the independent risk factors for ROP while GA, BW and preeclampsia in the Fourth Hospital in Shijiazhuang Conclusions: Retinopathy of prematurity incidence is different based on area. Incidence of ROP is still high in China. More efforts need to prevent ROP.

China ; Female ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; statistics & numerical data ; Male ; Retinopathy of Prematurity ; epidemiology ; Risk Factors

Aggressive posterior retinopathy of prematurity (AP-ROP) is a special kind of ROP, which is characterized by ill-defined, dilated and tortuous vessels in the posterior portion of the eye and rapidly progresses to severe ROP with retinal detachment. As more and more AP-ROP cases, who usually have poor prognosis, have been found, this disease has been increasingly noted. Which premature infants are at risks? How to make earlier diagnosis? Is there any better treatment protocols? There is much research about AP-ROP and this article summarizes the risks, screening, diagnosis and treatment of this disease.
Humans ; Infant, Newborn ; Prognosis ; Retinopathy of Prematurity ; epidemiology ; etiology ; therapy

OBJECTIVETo investigate the survival rate, complications during hospitalization, and prognostic factors in extremely preterm infants (gestational age less than 28 weeks) in the neonatal intensive care unit (NICU).

METHODSA retrospective analysis was performed on 90 extremely preterm infants who were admitted to the NICU between January 2011 and March 2013 to investigate the perinatal data, delivery and resuscitation, ventilation/oxygen supply during hospitalization, mortality, and the incidence of severe (grade III/IV) intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), and septicemia.

RESULTSAmong the 90 extremely preterm infants, the gestational age, birth weight, overall survival rate, mortality, and withdrawal rate were 26±1 weeks, 898±165 g, 57%, 9%, and 34%, respectively. The incidence rates of neonatal respiratory distress syndrome, BPD, PDA, ROP, and grade III/IV IVH were 88%, 85%, 69%, 68%, and 31%, respectively. The surviving infants had a mean length of hospital stay of 83±18 days and a mean weight at discharge of 2 419±300 g. The multivariate logistic regression analysis showed that grade III/IV IVH and pulmonary hemorrhage were high-risk factors for death or withdrawal, while antenatal corticosteroids were the protective factor for outcome (P<0.05).

CONCLUSIONSThe survival rate of extremely preterm infants is still much lower than that in developed countries. grade III/IV IVH, and pulmonary hemorrhage are important prognostic factors.

Bronchopulmonary Dysplasia ; epidemiology ; Ductus Arteriosus, Patent ; epidemiology ; Female ; Humans ; Infant Mortality ; Infant, Extremely Premature ; Infant, Newborn ; Logistic Models ; Male ; Prognosis ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Retinopathy of Prematurity ; epidemiology ; Retrospective Studies ; Survival Rate

OBJECTIVETo analyze the clinical features and prognosis of extremely low birth weight infants (ELBWI).

METHODData of totally 165 hospitalized ELBWI between August 1st, 2008 and November 30th, 2013 in Hunan Children's Hospital were analyzed. The information of general data and births, prenatal care, delivery room stabilization, transfer information, complications, treatment, outcome and follow up were summarized.

RESULT(1) One hundred and sixty-five ELBWI were involved, their mean gestational age was (28.4±2.4) weeks, mean birth weight(910.9±93.1) g. (2) Rate of delivery in tertiary hospital was 46.7% (77/165) and prenatal steroids exposure was found in 52.1% (86/165). None of the cases were treated with continuous positive airway pressure (CPAP) in delivery room. (3) Rate of infants who were transfered to the class III b neonatal ward within 12 hours after birth was 58.8% (97/165). (4) The main complications of them included neonatal respiratory distress syndrome(NRDS, 77.0%, 127/165), bronchopulmonary dysplasia (BPD, 70.1%, 75/107), patent ductus arteriosus (PDA, 50.0%, 40/80), preterm retinopathy (ROP, 43.0%, 46/107), sepsis 39.4% (65/165), intraventricular hemorrhage (IVH, 34.8%, 49/141), necrotizing enterocolitis (NEC, 8.0%, 7/88). (5) TREATMENT: 97.6% (161/165) received oxygen therapy and 66.1% (109/165) received mechanical ventilation, 55.2% (91/165) used CPAP. 89.8% (114/127) of the NRDS used PS; 44.0% (33/75) of the BPD used low dose dexamethasone, 32.0% (24/75) used low dose nitric oxide; 60.0% (24/40) of the PDA used medication. 32.6% (15/46) of the ROP received laser photocoagulation. The average time of beginning enteral feeding was 2.0 d, the mean time to achieve full gastrointestinal feeding was 43.4 d. (6) OUTCOME: rate of survival in 165 cases with ELBWI was 51.5% (85/165), treatment was abandoned in 37.6% (62/165), total mortality was 48.5% (80/165). There were significant difference in survival rate between different birth weight group, gestational age group and admission age group (χ2=11.498, 8.789, 13.157, all P<0.05); There was significant difference in rate of giving up treatment between different birth weight and admission age groups (χ2=10.448, 8.259, all P<0.05). The primary cause of death was economic factor and worrying about prognosis. (7) Follow up: rate of neurodevelopmental impairment (NDI) in part of follow up cases was 27.9% (12/43).

CONCLUSIONELBWI have many severe complications and sequelae, which need complex treatment and long hospital stay with a low survival rate. In order to improve the level of treatment, we need to improve the rate of prenatal steroids, carry out intrauterine and postnatal, transport of ELBWI to III b neonatal ward as early and rationally as possible, give professional, sophisticated and integrated treatment technologies as far as possible.

Birth Weight ; Bronchopulmonary Dysplasia ; diagnosis ; therapy ; Cerebral Hemorrhage ; diagnosis ; therapy ; China ; epidemiology ; Dexamethasone ; therapeutic use ; Ductus Arteriosus, Patent ; diagnosis ; therapy ; Enterocolitis, Necrotizing ; diagnosis ; therapy ; Gestational Age ; Humans ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; therapy ; Prognosis ; Respiratory Distress Syndrome, Newborn ; diagnosis ; therapy ; Retinopathy of Prematurity ; diagnosis ; therapy ; Sepsis ; diagnosis ; therapy ; Survival Rate ; Treatment Outcome

PURPOSE: This study aimed to identify the morbidity in very low birth weight infants (VLBWI) and low birth weight infants (LBWI) in Korea and compare these data with similar data from Japan and the USA. METHODS: The analysis of morbidity in VLBWI in Korea was based on a 2012 survey of morbidity in LBWI in Korea. These findings were compared with the morbidity of VLBWI and LBWI in Japan and the USA. RESULTS: Morbidities in LBWI included jaundice (58.5%), respiratory distress syndrome (RDS; 37.0%), apnea (22.2%), patent ductus arteriosus (PDA; 22.0%), and small for gestational age (SGA; 19.2%). The research findings concerning LBWI morbidity found, high prevalence rates for neonatal jaundice, RDS, PDA, SGA, apnea, and sepsis. Compared with VLBWI morbidity of Japan and the USA, intraventricular hemorrhage, RDS, PDA, and sepsis were more prevalent in Korea, whereas bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity occurred at similar frequencies in all 3 countries. CONCLUSION: This study provides a recent nationwide summary of disease-specific morbidity in VLBWI and LBWI in Korea. Based on this study, future research and surveys are needed to identify the disease-specific mortality and survival rates in the field of neonatal intensive care.
Apnea ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Epidemiology ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Japan* ; Jaundice ; Jaundice, Neonatal ; Korea ; Mortality ; Prevalence ; Retinopathy of Prematurity ; Sepsis ; Survival Rate

PURPOSE: To assess the long-term anatomic and visual outcomes and associated complications of lens-sparing vitrectomy (LSV) in infants with progressive posterior-type tractional retinal detachment (TRD) associated with stage 4A retinopathy of prematurity (ROP). METHODS: In a retrospective case series, the medical records of consecutive patients who presented with progressive posterior-type stage 4A ROP and underwent LSV between 1999 and 2007 were reviewed. Retinal attachment status, visual acuity, and development of postoperative complications were assessed. RESULTS: Eleven eyes of 9 patients were included. The mean follow-up period was 4.6 years. In 8 eyes (73%), plus disease was present at the time of LSV. In 3 eyes (27%), 2 (66%) without plus disease and 1 (13%) with plus disease, the retina remained reattached in the end, while 8 eyes (73%) had TRD on final examination. Two eyes with reattached retinas showed favorable visual acuity. In those eyes with detached retinas, 5 (68%) showed no light perception. When surgery for ROP was unsuccessful, development of cataract, corneal opacity, or glaucoma was common. CONCLUSIONS: The long-term anatomic success rate of LSV for progressive posterior-type stage 4A ROP was low, especially in the presence of plus disease at the time of LSV. Anatomical reattachment is very important for preventing complications and gaining better visual outcomes.
Disease Progression ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Complications/epidemiology ; Retinal Detachment/epidemiology ; Retinopathy of Prematurity/*surgery ; Retrospective Studies ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods