BACKGROUNDGlobally, the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China.

METHODSAll the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed.

RESULTSA total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal.

CONCLUSIONSNeonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.

Cause of Death ; China ; Female ; Hospital Mortality ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Newborn, Diseases ; mortality ; Intensive Care Units, Neonatal ; statistics & numerical data ; Male ; Perinatal Death ; Retrospective Studies

OBJECTIVETo study the effect of breastfeeding quality improvement on the breastfeeding rate in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU).

METHODSA retrospective analysis was performed for the clinical data of VLBW and ELBW infants who were admitted from July 2014 to July 2015 (pre-improvement group) and those who were admitted from August 2015 to June 2016 after the implementation of breastfeeding quality improvement measures (post-improvement group). The parameters including condition of breastfeeding (breastfeeding rate, breastfeeding amount, and breastfeeding time), duration of parenteral nutrition, time to enteral feeding, and incidence of feeding intolerance were compared between the two groups.

RESULTSThe implementation of breastfeeding quality improvement measures significantly increased breastfeeding rate and amount, significantly shortened time to addition of human milk fortifier, duration of parenteral nutrition, and time to enteral feeding, and significantly decreased the incidence of feeding intolerance.

CONCLUSIONSBreastfeeding quality improvement measures can increase breastfeeding rate in the NICU and decrease gastrointestinal complications in preterm infants.

Breast Feeding ; statistics & numerical data ; Enteral Nutrition ; Female ; Humans ; Infant, Extremely Low Birth Weight ; growth & development ; Infant, Newborn ; Infant, Very Low Birth Weight ; growth & development ; Intensive Care Units, Neonatal ; Male ; Parenteral Nutrition ; Quality Improvement ; Retrospective Studies ; Weight Gain

Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0-151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0-157.9 cm) and the third shortest maternal height quartiles (158.0-160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn's small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission.
Adult ; *Body Height ; Body Mass Index ; Female ; Hospitals ; Humans ; *Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Japan ; Logistic Models ; Male ; Mothers/*statistics & numerical data ; Odds Ratio ; Risk Factors ; Weight Gain

INTRODUCTIONLate preterm (LP) neonates (34 to 36 weeks gestation) are often managed like term neonates though current literature has identified them to have greater complications. The primary objective of our study was to evaluate and compare morbidity and resource utilisation in LPs especially in view of paucity of Asian studies in this regard.

MATERIALS AND METHODSA retrospective audit was carried out on 12,459 neonates born in KK Women's and Children's Hospital (KKWCH). The chief outcome measures were hypoglycaemia, hypothermia, respiratory morbidity, feeding problems and neonatal jaundice. Resource utilisation included neonatal intensive care unit (NICU) admission, mechanical ventilation, parenteral nutrition and length of hospitalisation.

RESULTSOf 12,459 deliveries, 1221 (10%) were LP deliveries with a significantly increasing trend of 8.6% to 10% from 2002 to 2008 (P = 0.001). Neonatal morbidity in the form of hypoglycaemia (34 weeks vs 35 to 36 weeks vs term: 26% vs 16% vs 1%); hypothermia (5% vs 1.7% vs 0.2%); feeding difficulties (30% vs 9% vs 1.4%); respiratory distress syndrome (RDS) (4% vs 1% vs 0.1%); transient tachypnea of the newborn (TTNB) (23% vs 8% vs 3%) and neonatal jaundice (NNJ) needing phototherapy (63% vs 24% vs 8%), were significantly different between the 3 groups, with highest incidence in 34-week-old infants. Resource utilisation including intermittent positive pressure ventilation (IPPV) (15% vs 3.5% vs 1%), total parenteral nutrition/intravenous (TPN/IV) (53% vs 17% vs 3%) and length of stay (14 ± 22 days vs 4 ± 4.7 days vs 2.6 ± 3.9 days) was also significantly higher (P <0.001) in LPs.

CONCLUSIONLP neonates had significantly higher morbidity and resource utilisation compared to term infants. Among the LP group, 34-week-old infants had greater complications compared to infants born at 35 to 36 weeks.

Clinical Audit ; Feeding Behavior ; Female ; Humans ; Hypoglycemia ; epidemiology ; Hypothermia ; epidemiology ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; utilization ; Intermittent Positive-Pressure Ventilation ; utilization ; Jaundice, Neonatal ; epidemiology ; therapy ; Length of Stay ; statistics & numerical data ; Male ; Parenteral Nutrition ; utilization ; Parenteral Nutrition, Total ; utilization ; Phototherapy ; Premature Birth ; epidemiology ; Respiration, Artificial ; utilization ; Respiratory Distress Syndrome, Newborn ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Transient Tachypnea of the Newborn ; epidemiology

BACKGROUNDWith the progress of perinatal medicine and neonatal technology, more and more extremely low birth weight (ELBW) survived all over the world. This study was designed to investigate the short-term outcomes of ELBW infants during their Neonatal Intensive Care Unit (NICU) stay in the mainland of China.

METHODSAll infants admitted to 26 NICUs with a birth weight (BW) < l000 g were included between January l, 2011 and December 31, 2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors.

RESULTSA total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age (GA) was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants (23.3%) died and another 69 infants (26.7%) died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas (53.6% vs. 35.3%, P = 0.019). BW < 750 g and GA < 28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization.

CONCLUSIONSOur study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.

China ; Female ; Humans ; Infant ; Infant Mortality ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; statistics & numerical data ; Male ; Morbidity ; Respiratory Distress Syndrome, Newborn ; mortality ; Retrospective Studies ; Surveys and Questionnaires

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

OBJECTIVE: To study the results of TEOAE and AABR hearing screening and follow-up in NICU. METHOD: Total 574 cases in NICU were included in this study, all cases received both TEOAE and AABR hearing screening while admission and rescreening when one-month-old. The cases that were abnormal on either test in rescreening were asked to return for diagnostic tests at 3 moths old. The patients who didn't return as required in 3 months were surveyed by call and analyzed. RESULT: Among 574 cases, 472 cases passed both TEOAE and AABR hearing screening while admission. While 102 cases had abnormal test results in either screening test. Thirty-three cases returned for follow-up, 13 of which passed rescreening test one month after discharge, the other 20 cases had ABR diagnostic tests after 3 months. Among them, 8 cases had normal hearing, 12 cases had various degree of hearing loss. Sixty-nine cases lost follow-up. The reason of lost follow-up was as follows, parents changed phone number/contact information, parents didn't understand the screening results, parents believe that their children having no need for further testing; parents had retest in other hospitals, parents didn't pay attention to hearing loss because of other severe complicated comorbidities. CONCLUSION The passing rate (normal) of TEOAE and AABR hearing screening in NICU was 82.2%, non- passing rate wass 17.8%, and the prevalence of hearing loss was high in those followed cases. Hyperbilirubinemia was the main risk factors of hearing loss in our NICU patients. We reviewed the reason for high rate (67.6%) of losing follow-up.
Female ; Follow-Up Studies ; Hearing Tests ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; statistics & numerical data ; Lost to Follow-Up ; Male ; Neonatal Screening ; Retrospective Studies

BACKGROUNDMany studies have shown a relationship between birth weight discordance and adverse perinatal outcomes. This study aimed to investigate the perinatal risk factors and neonatal complications of discordant twins who are admitted to the neonatal intensive care unit.

METHODSA total of 87 sets of twins were enrolled in this retrospective study, of which 22 sets were discordant twins and 65 sets were concordant twins. Binary Logistic regression analysis was used to identify the risk factors associated with the occurrence of discordant twins. The common neonatal complications of discordant twins were also investigated.

RESULTSMultivariate analysis showed that the use of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing were risk factors for the occurrence of discordant twins. The incidence of small for gestational age infants and very low birth weight infants of discordant twins was significantly higher, while the birth weight of discordant twins was significantly lower than those of concordant twins. The duration of hospitalization of discordant twins was longer than that of concordant twins. The incidence of several neonatal complications, such as neonatal respiratory distress syndrome and intracranial hemorrhage, was higher in discordant twins than that in concordant twins. The percentage of those requiring pulmonary surfactant and mechanical ventilation was significantly higher in discordant twins than that in concordant twins.

CONCLUSIONSUse of assisted reproductive techniques, pregnancy-induced hypertension, and unequal placental sharing are perinatal risk factors of discordant twins who are admitted to the neonatal intensive care unit. These infants are also much more likely to suffer from various neonatal complications, especially respiratory and central nervous system diseases. It is important to prevent the occurrence of discordant twins by decreasing these risk factors and timely treatment should be given to discordant twins.

Birth Weight ; physiology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; statistics & numerical data ; Male ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies ; Risk Factors ; Twins ; statistics & numerical data

PURPOSE: With the rapid increase in information technology in the medical environment, protection of patient's privacy is a crucial issue to hospital nurses. The purpose of this study was to determine neonatal nurses' perception and performance of behavior to protect patient privacy, and professional self-concept, and to investigate the relationships among these variables. METHODS: The participants in this descriptive correlation study were 182 nurses in nursery and neonatal intensive care units using EMR or OCS in November, 2011. RESULTS: Perception and performance averaged 4.61 and 4.04 (out of 5) respectively, and the average score for professional self-concept was 2.73 (out of 4). There was a significant difference between perception and performance. The performance of behaviour to protect patient privacy had a positive correlation with perception and professional self-concept. Multiple regression analysis showed that the key determinants of performance were recognition of necessity of patient privacy education, professional self-concept and perception, and these explained 36% of the total variance of performance. CONCLUSION: Study results indicate a need to establish policy to protect privacy of neonates and their families, and to develop educational programs to enhance neonatal nurses' perception and performance.
Education, Professional ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Nurseries ; Privacy ; Statistics as Topic

PURPOSE: This study was done to compare breast feeding rates and factors influencing feeding practice between late preterm (34< or =GA<37) and preterm infants (GA<34). METHODS: A survey was done of 207 late preterm and 117 preterm infants in neonatal intensive care units (NICU) of 4 university hospitals in D city. Data were collected from July 2009 to June 2010 from 324 medical records in the NICU. Breast-feeding at home was checked either by telephone survey or questioning during hospital visits. RESULTS: Rate of breast feeding for late preterm infants was significantly lower than for preterm infants. There was no significant difference in breast-feeding at home. We found differences in factors influencing breast feeding between the two groups. Factors influencing feeding for late preterm infants were type of delivery, mothers' occupation, feeding type during hospitalization, time elapse from hospital discharge, total admission days, infant's body weight at first feeding and length of NPO (nothing by mouth). Factors influencing feeding for preterm infants were birth order, maternal disease and obstetric complications, and one-minute Apgar score. CONCLUSION: Results of the study show low rates of breast-feeding for late preterm infants indicating a need for breast-feeding education for mothers of these infants.
Body Weight ; Breast Feeding/*statistics & numerical data ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Interviews as Topic ; Length of Stay ; Male ; Mothers/*psychology ; Occupations ; Time Factors