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Hou S, Yu Y, Wu Y, Cao Y, Zhang J, Liu Z, Guo C, Chen Y, Sun X, Li M, Gao Y, Zhao G, Niu S, Zhou Z, Wang Y, Yang Z, Huang L, Zhang C, Chen T, Zhao X, Li X, Zhang Y, Zhao P, Bi M, Zhao R. Association Between Antibiotic Overexposure and Adverse Outcomes in Very-Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis: A Multicenter Prospective Study. Indian J Pediatr 2022; 89:785-792. [PMID: 35286565 PMCID: PMC9279220 DOI: 10.1007/s12098-021-04023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the associations between higher antibiotic use rates (AURs) and adverse outcomes in very-low-birth-weight (VLBW) infants without culture-proven sepsis or necrotizing enterocolitis (NEC) in a multicenter of China. METHODS A prospective cohort study was performed on VLBW infants admitted to 24 neonatal intensive care units from January 1, 2018, to December 31, 2018. AUR was calculated as calendar days of antibiotic therapy divided by total hospital days. The composite primary outcome was defined as mortality or severe morbidity, including any of the following: severe neurologic injury, bronchopulmonary dysplasia (BPD), and stage 3 or higher retinopathy of prematurity. RESULTS A total of 1,034 VLBW infants who received antibiotics without culture-proven sepsis or NEC were included in this study. The overall AUR of eligible VLBW infants was 55%, and the AUR of each eligible VLBW infant ranged from 3 to 100%, with a median of 56% (IQR 33%, 86%). After generalized propensity score and logistic regression analysis of 4 groups of VLBW infants with different AUR range, infants in the higher quartile AUR, (Q3, 0.57~0.86) and (Q4, 0.87~1.00), had higher odds of composite primary outcome (adjusted OR: 1.81; 95% CI: 1.23-2.67; adjusted OR 2.37; 95% CI: 1.59-3.54, respectively) and BPD (adjusted OR: 3.09; 95% CI: 1.52-6.57; adjusted OR 3.17; 95% CI: 1.56-6.57, respectively) than those in the lowest AUR (Q1). CONCLUSIONS Antibiotic overexposure in VLBW infants without culture-proven sepsis or NEC was associated with increased risk of composite primary outcome and BPD. Rational empirical antibiotic use in VLBW infants is urgently needed in China.
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Affiliation(s)
- Shanshan Hou
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China. .,Department of Neonatology, Shandong Provincial Hospital Affliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Yanqiu Wu
- Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Yangyang Cao
- Department of Pediatrics, Taian City Central Hospital, Taian, China
| | - Jinghui Zhang
- Department of Neonatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhijie Liu
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Cheng Guo
- Department of Neonatology, Affiliated Hospital of Jining Medical College, Jining, China
| | - Yao Chen
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xuemei Sun
- Department of Neonatology, Linyi People's Hospital, Linyi, China
| | - Min Li
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, China
| | - Yanling Gao
- Department of Pediatrics, Dezhou People's Hospital, Dezhou, China
| | - Guoying Zhao
- Department of Pediatrics, Binzhou Medical University Hospital, Binzhou, China
| | - Shiping Niu
- Department of Neonatology, Zibo Maternity and Child Health Hospital, Zibo, China
| | - Zhiyuan Zhou
- Department of Pediatrics, Heze Municipal Hospital, Heze, China
| | - Yu Wang
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Zhenying Yang
- Department of Neonatology, Taian Maternity and Child Health Care Hospital, Taian, China
| | - Lei Huang
- Department of Neonatology, Shandong Maternal and Child Health Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chengyuan Zhang
- Department of Neonatology, W.F. Maternal and Child Health Hospital, Weifang, China
| | - Tong Chen
- Department of Neonatology, Dongying People's Hospital, Dongying, China
| | - Xinfeng Zhao
- Department of Neonatology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Xia Li
- Department of Neonatology, Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Yongfeng Zhang
- Department of Pediatrics, Affiliated Hospital of Weifang Medical College, Weifang, China
| | - Peng Zhao
- Department of Neonatology, Central People's Hospital of Tengzhou, Tengzhou, China
| | - Meirong Bi
- Department of Pediatrics, Jinan Central Hospital, Jinan, China
| | - Riming Zhao
- Department of Pediatrics, Juxian People's Hospital, Rizhao, China
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Wang L, Li J, Yu Y, Huang L, Huang X, Fan X, Zhang X, Zhang C, Liu Q, Sun A, Zhang Y, Cao Y, Xu P, Liu X, Wu J, Yang Z, Sun R, Ren X, Li J, Wan X, Qiu B, Niu S, Zhu R, Wang X, Zhang Y, Gao Y, Deng L, Shi J, Bi M. Initial respiratory support modality and outcome in preterm infants with less than 32 weeks of gestation in China: A multicentre retrospective cohort study. Paediatr Perinat Epidemiol 2022; 36:390-398. [PMID: 34431114 PMCID: PMC9291106 DOI: 10.1111/ppe.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND For initial respiratory management, continuous positive airway pressure (CPAP) is increasingly used for preterm infants, especially for gestational age less than 32 weeks. However, neonatologists are concerned about the potential risks of CPAP support failure. OBJECTIVES To examine the association between different initial respiratory support modalities and the outcomes of preterm infants at <32 weeks of gestation across multiple neonatal intensive care units (NICU) in China. METHODS This study was carried out over a period of 12 months in 2018. Unadjusted relative risks (RR) for demographic and clinical characteristics were calculated for CPAP failure and CPAP success in the total cohort using log-linear model based on generalised estimating equations for clustered observations. RESULTS Among 1560 preterm infants delivered at <32 weeks, the incidence of CPAP failure was 10.3%. After adjustment for demographic and clinical factors, the relative risk of mortality (RR 7.54, 95% CI 5.56, 10.44), pneumothorax (RR 9.85, 95% CI 2.89, 61.53), pulmonary haemorrhage (RR 7.78, 95% CI 4.51, 14.64) and BPD (RR 3.65, 95% CI 3.65, 4.51) were considerably higher for infants in the CPAP failure group than those in the CPAP-S group. However, the risk of poor outcomes in CPAP failure infants was similar to that of those in the initial mechanical ventilation (MV) group. CONCLUSIONS Continuous positive airway pressure failure was associated with an increased risk of mortality and major morbidities, including BPD, pulmonary haemorrhage and pneumothorax, and was comparable to the risk associated with initial MV.
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Affiliation(s)
- Li Wang
- The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina,Eyast Branch of Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Jia‐hui Li
- The First Affiliated Hospital of Shandong First Medical UniversityJinanChina
| | - Yong‐hui Yu
- Eyast Branch of Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Lei Huang
- Shandong Provincial Maternal and Child Health Care HospitalCheeloo College of MedicineShandong UniversityJinanChina
| | | | - Xiu‐fang Fan
- Jinan Maternity and Child Healthcare HospitalJinanChina
| | | | | | | | - Ai‐rong Sun
- Linyi Maternal and Child Health Care HospitalLinyiChina
| | - Yong‐feng Zhang
- Affiliated Hospital of Weifang Medical UniversityWeifangChina
| | | | - Ping Xu
- Liaocheng People's HospitalLiaochengChina
| | | | - Jing‐cai Wu
- Maternity and Child Health Care of ZaozhuangZaozhuangChina
| | | | | | - Xue‐yun Ren
- Affiliated Hospital of Jining Medical CollegeJiningChina
| | - Jing Li
- The Second Affiliated Hospital of Shandong First Medical UniversityJinanChina
| | - Xiao‐li Wan
- Jinan second Maternity and Child Health Care HospitalJinanChina
| | | | - Shi‐ping Niu
- Zibo Maternal and Child Health HospitalZiboChina
| | | | - Xiao‐kang Wang
- Central Branch of Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | | | | | | | - Jing Shi
- Liaocheng Second People's HospitalLiaochengChina
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3
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Guo S, Sun Q, Zhao X, Shen L, Zhen X. Prevalence and risk factors for antibiotic utilization in Chinese children. BMC Pediatr 2021; 21:255. [PMID: 34074254 PMCID: PMC8168021 DOI: 10.1186/s12887-021-02706-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China. METHODS English and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis. RESULTS Of 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver's self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue. CONCLUSION The prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.
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Affiliation(s)
- Shasha Guo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xinyang Zhao
- School of Nursing, China Medical University, Shenyang, 110100, China
| | - Liyan Shen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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Zhu Z, Yuan L, Wang J, Li Q, Yang C, Gao X, Chen S, Han S, Liu J, Wu H, Yue S, Shi J, Cheng R, Cheng X, Han T, Jiang H, Bao L, Chen C. Mortality and Morbidity of Infants Born Extremely Preterm at Tertiary Medical Centers in China From 2010 to 2019. JAMA Netw Open 2021; 4:e219382. [PMID: 33974055 PMCID: PMC8114138 DOI: 10.1001/jamanetworkopen.2021.9382] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Extreme prematurity is associated with a substantial burden on health care systems worldwide. However, little is known about the prognosis of infants born extremely preterm in developing countries, such as China. OBJECTIVE To describe survival and major morbidity among infants born extremely preterm in China over the past decade. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted from January 1, 2010, through December 31, 2019. Included individuals were infants with gestational age less than 28 weeks discharged from 1 of 68 neonatal intensive care units located in 31 provinces in China. Data were analyzed from August through October 2020. EXPOSURE Extremely preterm birth. MAIN OUTCOMES AND MEASURES Survival to discharge and major morbidity (ie, bronchopulmonary dysplasia, grades III-IV intraventricular hemorrhage, white matter injury, stage II-III necrotizing enterocolitis, sepsis, or severe retinopathy of prematurity) were measured. RESULTS Among 8514 eligible infants, 5295 (62.2%) were male and 116 infants (2.0%) were small for gestational age (SGA). Overall, 5302 infants (62.3%) survived to discharge. The survival rate was 1 of 21 infants (4.8%) at 22 weeks, 13 of 71 infants (18.3%) at 23 weeks, 144 of 408 infants (35.3%) at 24 weeks, 480 of 987 infants (48.6%) at 25 weeks, 1423 of 2331 infants (61.0%) at 26 weeks, and 3241 of 4692 infants (69.1%) at 27 weeks. Survival increased from 136 of 241 infants (56.4%; 95% CI, 50.1%-62.7%) in 2010 to 1110 of 1633 infants (68.0%; 95% CI, 65.7%-70.2%) in 2019 for infants born at 24 to 27 weeks (mean difference, 11.5%; 95% CI, 4.9%-18.2%; P < .001), without a significant change for infants born at less than 24 weeks. Major morbidity was found in 5999 of 8281 infants overall, for a rate of 72.4%, which increased from 116 of 223 infants (52.0%; 95% CI, 45.4%-58.6%) to 1363 of 1656 infants (82.3%; 95% CI, 80.5%-84.1%) from 2010 to 2019 (mean difference, 30.3%; 95% CI, 23.5%-37.1%, P < .001). Regional variations in survival were identified, with an almost 2-fold increase (1.94-fold; 95% CI, 1.66-2.27; P < .001) from 188 of 474 infants (39.7%) in northwest China to 887 of 1153 infants (76.9%) in north China. Gestational age (adjusted risk ratio [aRR], 1.084; 95% CI, 1.063-1.105; P < .001), birth weight (aRR, 1.028; 95% CI, 1.020-1.036; P < .001), premature rupture of membranes (aRR, 1.025; 95% CI, 1.002-1.048; P = .03), and antenatal steroids (aRR, 1.029; 95% CI, 1.004-1.055; P = .02) were associated with improved survival, while being born SGA (aRR, 0.801; 95% CI, 0.679-0.945; P = .01), being male (aRR, 0.975; 95% CI, 0.954-0.997; P = .02), multiple birth (aRR, 0.955; 95% CI, 0.929-0.982; P = .001), having a mother with gestational diabetes (aRR, 0.946; 95% CI, 0.913-0.981; P = .002), and low Apgar score (aRR, 0.951; 95% CI, 0.925-0.977; P < .001) were found to be risk factors associated with decreased chances of survival. CONCLUSIONS AND RELEVANCE This study found that infants born extremely preterm were at increased risk of mortality and morbidity in China, with a survival rate that improved over time and a major morbidity rate that increased. These findings suggest that more active and effective treatment strategies are needed, especially for infants born at gestational age 25 to 27 weeks.
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Affiliation(s)
- Zhicheng Zhu
- Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Lin Yuan
- Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Jin Wang
- Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Qiuping Li
- Department of Neonatology, Affiliated Bayi Children’s Hospital, Seventh Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Chuanzhong Yang
- Department of Neonatology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xirong Gao
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Shangqin Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuping Han
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jiangqin Liu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Wu
- Department of Neonatology, First Hospital of Jilin University, Changchun, China
| | - Shaojie Yue
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha, China
| | - Jingyun Shi
- Department of Neonatology, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China
| | - Rui Cheng
- Department of Neonatology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xiuyong Cheng
- Department of Neonatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tongyan Han
- Department of Neonatology, Peking University Third Hospital, Beijing, China
| | - Hong Jiang
- Department of Neonatology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Bao
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Chen
- Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
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Hei M, Gao X, Li Y, Gao X, Li Z, Xia S, Zhang Q, Han S, Gao H, Nong S, Zhang A, Li J, Wang Y, Ye XY, Lee SK. Family Integrated Care for Preterm Infants in China: A Cluster Randomized Controlled Trial. J Pediatr 2021; 228:36-43.e2. [PMID: 32898578 DOI: 10.1016/j.jpeds.2020.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore whether family integrated care (FICare) is feasible and improves the outcomes of preterm infants in China. STUDY DESIGN This was a multicenter prospective cluster-randomized controlled trial comparing FICare and standard care. The primary outcome was length of stay (LOS). Secondary outcomes were nosocomial infections, duration of supplemental oxygen, breastfeeding, and weight gain. Outcomes were compared using univariate and multivariable analyses adjusted for potential confounders and clustering. RESULTS We enrolled 601 preterm infants from 11 neonatal intensive care units (FICare, n = 298; control, n = 303). The unadjusted LOS was 30.81 vs 30.26 days (mean ratio, 1.02; 95% CI, 0.85-1.22; P = .85). After adjustment, outcomes in the FICare group were improved compared with the control group, including LOS (28.26 vs 35.04 days; mean ratio, 0.81; 95% CI, 0.72-0.91), total medical expenditures (mean ratio, 0.69; 95% CI, 0.53-0.90), weight gain velocity (15.73 vs 10.30 g/day; mean difference, 5.43; 95% CI, 3.65-7.21), duration of supplemental oxygen (13.11 vs 21.42 days; mean difference, 0.71; 95% CI, 0.50-1.00), nosocomial infection rates (4.13 vs 5.84/1000 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), antibiotic exposure (38.63 vs 57.32/100 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), breastfeeding rates (87.25% vs 55.78%; OR, 5.42; 95% CI, 3.25-9.05), and rehospitalization rates (3.65% vs 7.48%; OR, 0.47; 95% CI, 0.28-0.77). At follow-up to 18 months, breastfeeding rates and weight were significantly (P < .05) higher over time in the FICare group. CONCLUSIONS FICare was feasible in Chinese neonatal intensive care units and was associated with reduced hospital LOS, medical expenditures, and rates of adverse outcomes.
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Affiliation(s)
- Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center of Children's Health, Beijing, China.
| | - Xiangyu Gao
- Department of Pediatrics, Southeast University Affiliated Xuzhou Hospital, Xuzhou, Jiangsu, China
| | - Ying Li
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xirong Gao
- Department of Neonatology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - Shiwen Xia
- Department of Neonatology, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Qianshen Zhang
- Department of Neonatology, Shenzhen Maternal and Childcare Hospital, Shenzhen, Guangdong, China
| | - Shuping Han
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Hongxia Gao
- Department of Neonatology, Gansu Provincial Maternity and Childcare Hospital, Lanzhou, Gansu, China
| | - Shaohan Nong
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Aimin Zhang
- Department of Neonatology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jia Li
- Department of Neonatology, Kunming Maternal and Child Healthcare Hospital, Kunming, Yunnan, China
| | - Yanchen Wang
- Chinese Neonatal Network, Fudan Children's Hospital, Shanghai, China
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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