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*

Objective: To analyze the trends on mortalities of all-cause and deaths caused by chronic and non-communicable diseases (NCDs) among Chinese labor force population during 2007 to 2016. Methods: Data on cause-of-death that collected from the National Mortality Surveillance System was used to analyze the age and area-related specific crude mortality rates, age-standardized mortality rates and component ratios of NCDs, among the Chinese labor force population, during 2007 to 2016. Trend of crude mortality rates and mortality component ratios of the three major diseases (infectious diseases, maternal and infant diseases, nutritional deficiency diseases; NCDs; injuries) were analyzed. Age-standardized mortality of cancer, COPD, cardiovascular and cerebrovascular diseases were also analyzed by gender. Age-standardized mortality was calculated based on the Year 2010 Population Census of China. Joinpoint regression model was used to obtain annual percentage change and 95%CI was set for assessing the trend. Results: In 2016, the age-standardized all-cause mortality rate was 217.23 per 100 000 among the Chinese labor force population, but decreased by -2.8% (95%CI: -3.8%- -1.7%) annually from 2007 to 2016. The gap between different gender and regions gradually narrowed. The proportion of deaths caused by NCDs increased annually by 0.8% (95%CI: 0.7%-0.9%). The age-standardized mortality rate of NCDs appeared as 171.89/100 000, among the Chinese labor force population in 2016, showing a downward trend by -2.4% (95%CI:-3.3% - -1.4%). However, in females, there appeared the greatest decrease, with an average annual change of -3.3% (95%CI:-4.0% - -2.5%). Diseases as cancer, COPD, cardiovascular and cerebrovascular diseases all showed downward trends in the whole country, with an average range of -2.0% (95%CI: -2.6%--1.3%), -8.0% (95%CI: -8.9% - -7.1%), -1.5% (95%CI: -2.9% - -0.1%), -2.3% (95%CI: -2.8% - -1.8%) in a ten-year period, respectively. Conclusion: All-cause and age-standardized mortality rates caused by NCDs among Chinese labor force population were decreasing during 2007 to 2016. However, the constituent ratios appeared increasing, year by year. Close attention needs to be paid on NCDs which affecting the health of the labor force population in China.
Cause of Death/trends* ; China ; Chronic Disease/epidemiology* ; Employment ; Female ; Humans ; Infant ; Mortality/trends* ; Noncommunicable Diseases/mortality*

INTRODUCTIONThere is increased awareness of paediatric palliative care in Malaysia, but no local published data on home care services. We aimed to describe the paediatric experience at Hospis Malaysia, a community-based palliative care provider in Malaysia.

METHODSWe conducted a retrospective case note review of patients aged up to 21 years who were referred to Hospis Malaysia from 2009 to 2013.

RESULTSA total of 137 patients (92 male, 45 female) with a median age of 140 (3-250) months were included in this study. The majority (71.5%) had malignancies. At referral, 62 patients were still in hospital and 17 died prior to discharge. A total of 108 patients received home visits. At the first home visit, 89.8% of patients had at least one physical symptom. Pain was the most common (52.5%) symptom. Patients had various supportive devices: 39 were on feeding tubes, ten had tracheostomies, five were on bilevel positive airway pressure and ten had urinary catheters. 66 families discussed the preferred location of care at end-of-life. Among those who died, 78.9% died at home, as they preferred (p < 0.001). Regression analysis showed no statistically significant association between a home death and age, diagnosis and number of home visits. Bereavement follow-up occurred for 93.3% of families.

CONCLUSIONCommunity care referrals tend to occur late, with 25.5% of patients dying within two weeks of referral. At referral, patients often had untreated physical symptoms. The majority of families preferred and had a home death.

Cause of Death ; trends ; Child, Preschool ; Female ; Follow-Up Studies ; Home Care Services ; organization & administration ; Humans ; Infant ; Malaysia ; epidemiology ; Male ; Neoplasms ; mortality ; therapy ; Palliative Care ; organization & administration ; Retrospective Studies ; Survival Rate ; trends

The aim of this study was to investigate the relationship between survival and incidence of bronchopulmonary dysplasia (BPD) in extremely premature infants, and identify clinical factors responsible for this association. Medical records of 350 infants at 23-26 weeks gestation from 2000 to 2005 (period I, n = 137) and 2006 to 2010 (period II, n = 213) were retrospectively reviewed. The infants were stratified into 23-24 and 25-26 weeks gestation, and the survival, BPD incidence, and clinical characteristics were analyzed. BPD was defined as oxygen dependency at 36 weeks postmenstrual age. The overall survival rate was significantly improved in period II compared to period I (80.3% vs. 70.0%, respectively; P = 0.028), especially in infants at 23-24 weeks gestation (73.9% vs. 47.4%, respectively; P = 0.001). The BPD incidence in survivors during period II (55.0%) was significantly decreased compared to period I (67.7%; P = 0.042), especially at 25-26 weeks gestation (41.7% vs. 62.3%, respectively; P = 0.008). Significantly improved survival at 23-24 weeks gestation was associated with a higher antenatal steroid use and an improved 5-minute Apgar score. A significant decrease in BPD incidence at 25-26 weeks gestation was associated with early extubation, prolonged use of less invasive continuous positive airway pressure, and reduced supplemental oxygen. Improved perinatal and neonatal care can simultaneously lead to improved survival and decreased BPD incidence in extremely premature infants.
Adult ; Bronchopulmonary Dysplasia/epidemiology/*mortality ; Demography ; Female ; Gestational Age ; Humans ; Incidence ; Infant, Extremely Premature ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Multivariate Analysis ; Odds Ratio ; Pregnancy ; Retrospective Studies ; Severity of Illness Index ; Survival Rate/*trends

Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate (IMR), maternal mortality rate (MMR) and under 5 mortality rate (U5MR) had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR (65.05%); whereas, western rural China had the greatest reduction in MMR (72.99%) but smallest reduction in U5MR (57.36%). Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators (odds ratios): IMR (central: 2.13; western: 5.31), U5MR (central: 2.25; western: 5.69), MMR (central: 1.94; western: 3.31), and prevalence of infectious diseases (central: 1.62; western: 3.58). The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health disparities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.
China ; epidemiology ; Cross-Sectional Studies ; Female ; Health Promotion ; economics ; legislation & jurisprudence ; organization & administration ; Healthcare Disparities ; economics ; trends ; Humans ; Infant ; Infant Mortality ; trends ; Maternal Mortality ; trends ; Mortality ; trends ; Regression Analysis ; Rural Population ; statistics & numerical data ; Socioeconomic Factors

This study attempted to assess the risk factors for mortality of very-low-birth-weight (VLBW) infants in the neonatal intensive care unit (NICU, n=2,386). Using data from the Korean Neonatal Network, we investigated infants with birth weights <1,500 g and gestational ages (GAs) of 22-31 weeks born between January 2013 and June 2014. Cases were defined as death at NICU discharge. Controls were randomly selected from live VLBW infants and frequency matched to case subjects by GA. Relevant variables were compared between the cases (n=236) and controls (n=236) by Cox proportional hazards regression to determine their associations with cause-specific mortality (cardiorespiratory, neurologic, infection, gastrointestinal, and others). In a Cox regression analysis, cardiorespiratory death were associated with a foreign mother (hazard ratio, HR, 4.33; 95% confidence interval, CI, 2.08-9.02), multiple gestation (HR, 1.65; 95% CI, 1.07-2.54), small for gestational age (HR, 2.06; 95% CI, 1.25-3.41), male gender (HR, 1.69; 95% CI, 1.10-2.60), Apgar score < or =3 at 5 min (HR, 1.97; 95% CI, 1.18-3.31), and delivery room resuscitation (HR, 2.60; 95% CI, 1.53-4.40). An Apgar score < or =3 at 5 min was also associated with neurological death (HR, 2.95; 95% CI, 1.29-6.73). Death due to neonatal infection was associated with outborn delivery (HR, 5.09; 95% CI, 1.46-17.74). Antenatal steroid and preterm premature rupture of membranes reduced risk of cardiorespiratory death (HR, 0.43; 95% CI, 0.27-0.67) and gastrointestinal death (HR, 0.30; 95% CI, 0.13-0.70), respectively. In conclusion, foreign mother, multiple gestation, small gestation age, male gender, Apgar score < or =3 at 5 min, and resuscitation in the delivery room are associated with cardiorespiratory mortality of VLBW infants in NICU. An Apgar score < or =3 at 5 min and outborn status are associated with neurological and infection mortality, respectively.
Apgar Score ; Cohort Studies ; Databases, Factual ; Female ; Gestational Age ; Humans ; Infant ; *Infant Death ; *Infant Mortality/trends ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Kaplan-Meier Estimate ; Male ; Pregnancy ; Pregnancy, Multiple ; Proportional Hazards Models ; Republic of Korea ; Resuscitation ; Risk Factors ; Sex Factors

Recently the Korean Neonatal Network (KNN) was established in order to enhance treatment outcomes further through the registration of very-low-birth-weight infants (VLBWI) data. The present study was conducted on 2,606 VLBWI, 2,386 registered and 220 un-registered, in the KNN participating centers, with the objective of reporting on recent survival rates of VLBWI in Korea and verifying the changing trends in survival rates with data from the 1960s and beyond. The study also aimed to compare the premature infants' survival rate in Korea with those reported in neonatal networks of other countries. The recent survival rate of VLBWI increased more than twice from 35.6% in the 1960s to 84.8%, and the survival rate of the extremely low birth weight infants (ELBWI) increased by more than 10 times, indicating improvement of the survival rate in premature infants with lower birth weight and gestational age. Comparison of VLBWI between countries showed improved survival rates according to each birth weight group in Canada, Australia-New Zealand, and European countries with Japan at the head, but in terms of comparison based on gestational age, differences, except for Japan, have been reduced. Efforts to increase the survival rate of premature infants in Korea with low birth rate are inevitable, and they should be the foundation of academic and clinical development based on its network with advanced countries.
Databases, Factual ; Europe ; Gestational Age ; Humans ; Infant ; Infant Mortality/*trends ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature ; *Infant, Very Low Birth Weight ; Japan ; Republic of Korea

OBJECTIVES: Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea. METHODS: Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012. RESULTS: The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012). CONCLUSIONS: In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.
Cause of Death ; Child Mortality/*trends ; Child, Preschool ; Communicable Diseases/mortality ; Databases, Factual ; Female ; Humans ; Infant ; Male ; Neoplasms/mortality ; Nervous System Diseases/mortality ; Republic of Korea ; Sex Ratio ; Vital Statistics

Adult ; Age Factors ; Aged ; Cause of Death ; trends ; China ; Female ; Humans ; Infant ; Male ; Middle Aged ; Neoplasms ; mortality

Globally, pneumonia is the leading cause of childhood mortality. Pneumonia is the second killer of children less than 5 years of age in China. The World Heath Organization and United Nations Children′s Fund launched the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) in 2013. The ambitious goal is to end preventable childhood deaths due to pneumonia by 2025. Countries or regions should achieve the following goals: (1) reduce mortality from pneumonia in children less than 5 years of age to fewer than 3 per 1 000 live births; (2) reduce the incidence of severe pneumonia by 75% in children less than 5 years of age compared to 2010 levels. If the implementation of key interventions is accelerated, the mortality rate of childhood pneumonia will drop substantially every year, which makes the goal achievable.
Child Mortality ; trends ; Child, Preschool ; China ; epidemiology ; Humans ; Infant ; Infant, Newborn ; Pneumonia ; mortality ; Time Factors