4
|
Hei M, Li X, Shi Y, Cao Y, Sun J, Wu H, Jiang S, Ma X, Wang Y, Sun H, Zhang H, Du LZ, Zhou W, Lee SK, Chen C. Chinese Neonatal Network: a national protocol for collaborative research and quality improvement in neonatal care. BMJ Open 2022; 12:e051175. [PMID: 35501095 PMCID: PMC9062799 DOI: 10.1136/bmjopen-2021-051175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The objective of the Chinese Neonatal Network (CHNN) is to provide a platform for collaborative research, outcomes evaluation and quality improvement for preterm infants with gestational age less than 32 weeks in China. The CHNN is the first national neonatal network and has the largest geographically representative cohort from neonatal intensive care units (NICUs) in China. METHODS AND ANALYSIS Individual-level data from participating NICUs will be collected using a unique database developed by the CHNN on an ongoing basis from January 2019. Data will be prospectively collected from all infants <32 weeks gestation or <1500 g birth weight at 58 participating NICUs. Infant outcomes and inter-institutional variations in outcomes will be examined and used to inform quality improvement measures aimed at improving outcomes. Information about NICU environmental and human resource factors and processes of neonatal care will also be collected and analysed for association with outcomes. Clinical studies, including randomised controlled trials will be conducted using the CHNN data platform. ETHICS AND DISSEMINATION This study was approved by the ethics review board of Children's Hospital of Fudan University, which was recognised by all participating hospitals. Waiver of consent were granted at all sites. Only non-identifiable patient level data will be transmitted and only aggregate data will be reported in CHNN reports and publications.
Collapse
Affiliation(s)
- Mingyan Hei
- Neonatal Center, Beijing Children's Hospital Capital Medical University, Beijing, China
- Neonatal Center, National Center for Children's Health, Beijing, China
| | - Xiaoying Li
- Department of Neonatology, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Cao
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jianhua Sun
- Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wu
- Neonatology, The First Bethune Hospital of Jilin University, Changchun, Jilin, China
| | - Siyuan Jiang
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaolu Ma
- Neonatology, The Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanchen Wang
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Huiqing Sun
- Division of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- Children's Hospital of Henan Zhengzhou, Zhengzhou, China
| | - Huayan Zhang
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Li-Zhong Du
- The Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhao Zhou
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Chao Chen
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| |
Collapse
|
6
|
吴 新, 谷 传, 韩 树, 邓 晓, 陈 筱, 王 淮, 李 双, 王 军, 周 勤, 侯 玮, 高 艳, 韩 良, 刘 红, 余 章, 王 增, 李 娜, 李 海, 周 金, 陈 珊, 姜 善, 路 星, 潘 兆, 陈 小. A multicenter retrospective study on survival rate and complications of very preterm infants. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:814-820. [PMID: 34511171 PMCID: PMC8428915 DOI: 10.7499/j.issn.1008-8830.2102037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the survival rate and the incidence of complications of very preterm infants and the factors influencing the survival rate and the incidence of complications. METHODS The medical data of the very preterm infants with a gestational age of <32 weeks and who were admitted to the Department of Neonatology in 11 hospitals of Jiangsu Province in China from January 2018 to December 2019 were retrospectively reviewed. Their survival rate and the incidence of serious complications were analyzed. A multivariate logistic regression analysis was used to evaluate the risk factors for death and serious complications in very preterm infants. RESULTS A total of 2 339 very preterm infants were enrolled, among whom 2 010 (85.93%) survived and 1 507 (64.43%) survived without serious complications. The groups with a gestational age of 22-25+6 weeks, 26-26+6 weeks, 27-27+6 weeks, 28-28+6 weeks, 29-29+6 weeks, 30-30+6 weeks, and 31-31+6 weeks had a survival rate of 32.5%, 60.6%, 68.0%, 82.9%, 90.1%, 92.3%, and 94.8% respectively. The survival rate tended to increase with the gestational age (P<0.05) and the survival rate without serious complications in each gestational age group was 7.5%, 18.1%, 34.5%, 52.2%, 66.7%, 75.7%, and 81.8% respectively, suggesting that the survival rate without serious complications increased with the gestational age (P<0.05). The multivariate logistic regression analysis showed that high gestational age, high birth weight, and prenatal use of glucocorticoids were protective factors against death in very preterm infants (P<0.05), and 1-minute Apgar score ≤3 was a risk factor for death in very preterm infants (P<0.05); high gestational age and high birth weight were protective factors against serious complications in very preterm infants who survived (P<0.05), while 5-minute Apgar score ≤3 and maternal chorioamnionitis were risk factors for serious complications in very preterm infants who survived (P<0.05). CONCLUSIONS The survival rate is closely associated with gestational age in very preterm infants. A low 1-minute Apgar score (≤3) may increase the risk of death in very preterm infants, while high gestational age, high birth weight, and prenatal use of glucocorticoids are associated with the reduced risk of death. A low 5-minute Apgar score (≤3) and maternal chorioamnionitis may increase the risk of serious complications in these infants, while high gestational age and high birth weight may reduce the risk of serious complications.
Collapse
Affiliation(s)
| | - 传丽 谷
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| | - 树萍 韩
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| | | | | | | | | | - 军 王
- 徐州医科大学附属医院新生儿科,江苏徐州221002
| | | | | | - 艳 高
- 连云港市妇幼保健院新生儿科,江苏连云港222000
| | | | | | - 章斌 余
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| | | | | | | | | | - 珊珊 陈
- 徐州医科大学附属医院新生儿科,江苏徐州221002
| | | | | | | | - 小慧 陈
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| |
Collapse
|
7
|
Lee SK, Beltempo M, McMillan DD, Seshia M, Singhal N, Dow K, Aziz K, Piedboeuf B, Shah PS. Outcomes and care practices for preterm infants born at less than 33 weeks' gestation: a quality-improvement study. CMAJ 2020; 192:E81-E91. [PMID: 31988152 DOI: 10.1503/cmaj.190940] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.
Collapse
Affiliation(s)
- Shoo K Lee
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Marc Beltempo
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Douglas D McMillan
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Mary Seshia
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Nalini Singhal
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Kimberly Dow
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Khalid Aziz
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Bruno Piedboeuf
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Prakesh S Shah
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont.
| | | |
Collapse
|