Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across...
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.760646/full |
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| author | Ruimiao Bai Siyuan Jiang Siyuan Jiang Jinzhen Guo Shanyu Jiang Shoo K. Lee Shoo K. Lee Shoo K. Lee Zhankui Li Yun Cao Yun Cao |
| author_facet | Ruimiao Bai Siyuan Jiang Siyuan Jiang Jinzhen Guo Shanyu Jiang Shoo K. Lee Shoo K. Lee Shoo K. Lee Zhankui Li Yun Cao Yun Cao |
| author_sort | Ruimiao Bai |
| collection | DOAJ |
| description | Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions.Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions.Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China. |
| first_indexed | 2024-12-18T01:41:11Z |
| format | Article |
| id | doaj.art-9092dc3b59f8411a82bbea555c990179 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-18T01:41:11Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj.art-9092dc3b59f8411a82bbea555c9901792022-12-21T21:25:19ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-11-01910.3389/fped.2021.760646760646Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort StudyRuimiao Bai0Siyuan Jiang1Siyuan Jiang2Jinzhen Guo3Shanyu Jiang4Shoo K. Lee5Shoo K. Lee6Shoo K. Lee7Zhankui Li8Yun Cao9Yun Cao10Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, ChinaDepartment of Neonatology, Children's Hospital of Fudan University, Shanghai, ChinaNHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, ChinaDepartment of Neonatology, Northwest Women's and Children's Hospital, Xi'an, ChinaDepartment of Neonatology, The Affiliated Wuxi Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, ChinaMaternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, CanadaDepartment of Pediatrics, University of Toronto, Toronto, ON, CanadaDepartment of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, CanadaDepartment of Neonatology, Northwest Women's and Children's Hospital, Xi'an, ChinaDepartment of Neonatology, Children's Hospital of Fudan University, Shanghai, ChinaNHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, ChinaBackground: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions.Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions.Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China.https://www.frontiersin.org/articles/10.3389/fped.2021.760646/fullpreterm infantsdischarge against medical adviceintraventricular hemorrhageperiventricular leukomalaciabronchopulmonary dysplasianecrotizing enterocolitis |
| spellingShingle | Ruimiao Bai Siyuan Jiang Siyuan Jiang Jinzhen Guo Shanyu Jiang Shoo K. Lee Shoo K. Lee Shoo K. Lee Zhankui Li Yun Cao Yun Cao Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study Frontiers in Pediatrics preterm infants discharge against medical advice intraventricular hemorrhage periventricular leukomalacia bronchopulmonary dysplasia necrotizing enterocolitis |
| title | Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study |
| title_full | Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study |
| title_fullStr | Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study |
| title_full_unstemmed | Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study |
| title_short | Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study |
| title_sort | variation of neonatal outcomes and care practices for preterm infants 34 weeks gestation in different regions of china a cohort study |
| topic | preterm infants discharge against medical advice intraventricular hemorrhage periventricular leukomalacia bronchopulmonary dysplasia necrotizing enterocolitis |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.760646/full |
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