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Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during
Fan Wu1,2, Guosheng Liu3, Zhoushan Feng2
1Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
Insights
Survival rates for extremely preterm (EP) infants in China improved annually, but remain lower than in developed nations. Medical care withdrawal significantly impacts outcomes for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Perinatology
- Public Health
Background:
- Extremely preterm (EP) infant survival is increasing globally, yet data from China remain limited.
- This study addresses the need for data on EP infant outcomes in Guangdong province, China.
Purpose of the Study:
- To investigate the short-term outcomes of extremely preterm infants at discharge in Guangdong province, China.
- To identify factors associated with survival and complications in this population.
Main Methods:
- Retrospective and prospective review of hospitalization records for 2051 extremely preterm infants discharged from 26 NICUs between 2008 and 2017.
- Analysis of demographic data, clinical outcomes, complications, and survival rates.
Main Results:
- The overall survival rate at discharge was 52.5%, with significant improvements observed annually from 2008 to 2017.
- Key complications included respiratory distress syndrome (88.0%), retinopathy of prematurity (45.1%), and intraventricular hemorrhages (37.4%).
- Factors associated with improved survival included higher gestational age, birth weight, specialist hospital discharge, and antenatal steroid use.
Conclusions:
- While survival rates for EP infants in China are improving, they lag behind developed countries, with medical care withdrawal being a significant concern.
- Discharge from specialist hospitals and higher socioeconomic factors correlate with better outcomes.
- Continued efforts in neonatal care are crucial for further improving survival and reducing complications in extremely preterm infants in China.
Background:
An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province.
Methods:
A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008-2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed.
Results:
During 2008-2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival.
Conclusions:
Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.
