Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008-2017

Wu, F; Liu, GS; Feng, ZS; Tan, XH; Yang, C; Ye, X; Dai, Y; Liang, W; Ye, XZ; Mo, J; Ding, L; Wu, BQ; Chen, HX; Li, CW; Zhang, Z; Rong, X; Shen, W; Huang, WM; Yang, BY; Lv, JF; Huo, LY; Huang, HW; Rao, HP; Yan, WK; Yang, Y; Ren, XJ; Wang, FF; Liu, D;

Liu, GS (reprint author), Jinan Univ, Affiliated Hosp 1, Dept Neonatol, Guangzhou 510630, Guangdong, Peoples R China.; Cui, QL (reprint author), Guangzhou Med Univ, Affiliated Hosp 3, Dept Pediat, Guangzhou 510150, Guangdong, Peoples R China.

BMC PEDIATRICS, 2019; 19 (1):

Abstract

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.

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