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Care Practices, Morbidity and Mortality of Preterm Neonates in China, 2013-2014: a Retrospective study
Fengdan Xu1,2,3, Xiangyong Kong3, Shunyan Duan4
1Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, 523325, China.
Insights
Preterm birth prevalence in China was 9.9%. Survival rates for extremely preterm infants (<28 weeks) remain low, highlighting the need for improved maternal and neonatal care practices.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Background:
- Preterm birth is a significant global health concern.
- Understanding the outcomes and risk factors for preterm neonates is crucial for improving care.
- Data on preterm infant care in China is essential for regional health strategies.
Purpose of the Study:
- To determine the prevalence of preterm birth in China.
- To analyze morbidity, mortality, and care practices for preterm neonates.
- To identify perinatal risk factors associated with preterm neonatal mortality.
Main Methods:
- Retrospective cohort study design.
- Inclusion of data from 13,701 preterm neonates across 15 Chinese hospitals (2013-2014).
- Analysis of demographic data, medical interventions, and survival outcomes.
Main Results:
- Prevalence of preterm birth was 9.9%.
- Mechanical ventilation was common for infants 24-27 weeks (56.1%).
- Antenatal steroid use was suboptimal across gestational ages.
- Overall mortality was 1.9%, with higher mortality in the 24-27 week group.
- Survival to discharge increased with gestational age, from 68.2% (24-27 weeks) to 99.4% (34-36 weeks).
- Key mortality risk factors included low birth weight, lack of antenatal steroids, and neonatal asphyxia.
Conclusions:
- Most preterm neonates (28-36 weeks) survived without major morbidity.
- Survival rates for extremely preterm infants (<28 weeks) remain low.
- Maternal and neonatal care practices require enhancement, particularly for very preterm births.
Abstract:
This retrospective cohort study aimed to investigate the prevalence, morbidity, mortality and the maternal/neonatal care of preterm neonates and the perinatal risk factors for mortality. We included data on 13,701 preterm neonates born in 15 hospitals for the period 2013-2014 in China. Results showed a prevalence of preterm neonates of 9.9%. Most infants at 24-27 weeks who survived more than 12 hours were mechanically ventilated (56.1%). Few infants born before 28 weeks received CPAP without first receiving mechanical ventilation (8.1%). Few preterm neonates received antenatal steroid(35.8% at 24-27 weeks, 57.9% at 28-31 weeks, 57.0% at 32-33 weeks and 32.7% at 34-36 weeks). Overall mortality was 1.9%. Most of the deaths at 24-27 weeks of gestation occurred within 12 hours after birth, accounting for 68.1%(32/47), and within 12-72 hours after birth at 28-36 weeks of gestation, accounting for 47.4%(99/209). Rates of survival to discharge increased from 68.2% at 24-27 weeks, 93.3% at 28-31 weeks, 99.2% at 32-33 weeks to 99.4% at 34-36 weeks. The smaller of the GA, there was a greater risk of morbidities due to prematurity. Preterm birth weight (OR = 0.407, 95% CI 0.346-0.478), antenatal steroid (OR = 0.680, 95% CI 0.493-0.938), and neonatal asphyxia (OR = 3.215, 95% CI 2.180-4.741) proved to significantly influence the odds of preterm neonatal death. Overall, our results support that most of the preterm neonates at 28-36 weeks of gestation survived without major morbidity. Rate of survival of GAs less than 28 weeks was still low. Maternal and infant care practices need to be improved in the very preterm births.
