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Lyu T, Ye R, Li LL, Zhang LL, Xiao J, Ma YL, Li F, Rong H, Liu D, Wang H, Wang Y, Gu WW, Xuan Y, Chen X, Fan QL, Tang YF, Huang XH, Qin A, Zhang YL, Dou Y, Hu XJ. The effect of developmental care on the length of hospital stay and family centered care practice for very low birth weight infants in neonatal intensive care units: A cluster randomized controlled trial. Int J Nurs Stud 2024; 156:104784. [PMID: 38788261 DOI: 10.1016/j.ijnurstu.2024.104784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/12/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Despite previous studies suggesting that developmental care can provide benign stimulation to promote neural development of newborns, more evidence is needed regarding the other clinical benefits of developmental care. OBJECTIVE To evaluate the effect of implementing developmental care on the length of hospital stay, the improvement of care practice in neonatal intensive care units, as well as the short-term outcome of very low birth weight infants. DESIGN Cluster-randomized controlled trial. SETTING(S) AND PARTICIPANTS From March 1, 2021 to March 1, 2022, 1400 very low birth weight infants were recruited from 14 tertiary neonatal intensive care units in China. METHODS We assigned 14 neonatal intensive care units to either developmental care or standard care. The length of hospital stay of the infants was the primary outcome analyzed at the individual level. Secondary outcomes were family centered care practice including parental involvement, the skin to skin care, exclusive breast milk, oral immune therapy and breastfeeding. The environmental management (noise and light) and the short-term outcomes were also evaluated. RESULTS The length of hospital stay for the developmental care group was 65 % as long as that for the control group (HR: 0.65, 95 % CI, 0.451-0936, p = 0.021). After controlling the covariables, the adjusted HR = 0.755 (95 % CI, 0.515 to 1.107, p = 0.150). When compared to the control group, the developmental care group had greater access to SSC, with 22 infants (3.8 %) in the developmental care group compared to 13 infants (1.7 %) in the standard care group (p = 0.013). A greater proportion of infants in the developmental care group were fed at the breast, than those in the standard care group (136 [23.6 %] vs 9 [1.1 %]; p = 0.029). Compared to the control group, exclusively breast milk was significantly more favorable in the developmental care group (435 [75.6 %] vs 114 [15.0 %]; p = 0.001). The difference remained significant even after adjusting for covariates. However, the rate of oral immune therapy and parental involvement was similar in the two groups. The average noise and light levels in the developmental care group were significantly lower than those in the standard care group. After adjusting for confounders, the difference remained significant. There were no significant differences among groups in the mortality and major morbidity. CONCLUSIONS Developmental care might have developed an accumulated effect over time on the length of hospital stay among very low birth weight infants. The implementation of developmental care can greatly improve family centered care practices and the neonatal intensive care unit environment. REGISTRATION ClinicalTrials.govNCT05166720. Registration date: 1 March, 2021.
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Affiliation(s)
- TianChan Lyu
- Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, China; Children's Hospital of Fudan University, Shanghai, China
| | - Ruming Ye
- Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, China
| | - Li Ling Li
- Children's Hospital of Fudan University, Shanghai, China
| | - Li Li Zhang
- First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Juan Xiao
- First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Yue Lan Ma
- Suzhou Municipal Hospital, Jiangsu, China
| | - Fang Li
- Nanjing Children's Hospital, Jiangsu, China
| | - Hui Rong
- Nanjing Children's Hospital, Jiangsu, China
| | - Dan Liu
- Zhejiang Maternal Hospital, Zhejiang, China
| | - Hua Wang
- Zhejiang Maternal Hospital, Zhejiang, China
| | - Yan Wang
- Anhui Provincial Children's Hospital, Anhui, China
| | - Wei Wei Gu
- Ningbo Women and Children's Hospital, Zhejiang, China
| | - Yan Xuan
- Hainan Women and Children's Medical Center, Hainan, China
| | - XiaoChun Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | | | | | - Xiang Hui Huang
- Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, China
| | - An Qin
- Shanghai Jiao Tong University School of Medicine Affiliated International Peace Maternal and Child Health Hospital, Shanghai, China
| | | | - Yalan Dou
- Children's Hospital of Fudan University, Shanghai, China
| | - Xiao Jing Hu
- Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, China; Children's Hospital of Fudan University, Shanghai, China; Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, China.
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Lyu T, Tao Y, Hua W, Li L, Tang Y, Jin Y, Wang Y, Ma Y, Ji F, Dou Y, Cao Y, Hu XJ. Care practices and short-term clinical outcomes of very low birth weight infants in Yangtze River Delta in China. BMC Pediatr 2022; 22:676. [PMID: 36418987 PMCID: PMC9685934 DOI: 10.1186/s12887-022-03749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Intensive care is of great significance for very low birth weight infants (VLBWI). The Yangtze River Delta is the most ecomonically developed area in China. However, there are few data on the care practices and survival of VLBWI in this region. OBJECTIVES To investigate the prevalence, care practices and motality of VLBWI in Yangtze River Delta in China. METHODS A multi-center retrospective investigation study was conducted at five tertiary hospitals within the Yangtze River Delta in China from January to December 2017. Clinical data included the general characteristics of the infants and the mothers, clinical prognosis, care practices in NICUs was collected by trained research members. RESULTS During the study period, 1059 VLBWIs were included. Infants with birth weight < 750 g, 750-1000 g, 1000-1250 g and 1250-1500 g accounted for 2.3, 14.9, 34.8 and 47.8%, respectively. Premature rupture of membranes (17.8%) was the main cause of premature delivery. The catheterization rates of umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) were 25.0 and 64.4%, respectively. The duration of parenteral nutrition was 27.0 ± 19.5 d, the meantime of feeding tube indwelling was 36.2 ± 24.2 d. The corrected gestational age of the infants who reached full oral feeding was 35.8 ± 2.7 weeks. The breast feeding rate in the investigated infants was 61.9%. The mortality rate of preterm infants was 3.4%. The incidence of main complications BPD, PDA, ROP, NEC and sepsis were 24.9, 29.9, 21.7, 9.4 and 13.3% respectively. CONCLUSIONS Maternal and infant care practices need to be improved in the very preterm births. This study provides a baseline for the improvement in the further study.
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Affiliation(s)
- Tianchan Lyu
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Yibo Tao
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Wei Hua
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Liling Li
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Yunfei Tang
- Wuxi Children’s Hospital, Wuxi, Jiangsu China
| | - Yumei Jin
- Ningbo Women and Children’s Hospital, Ningbo, Zhejiang China
| | - Yan Wang
- grid.489986.20000 0004 6473 1769Anhui Provincial Children’s Hospital, Hefei, Anhui China
| | - Yuelan Ma
- grid.440227.70000 0004 1758 3572Suzhou Municipal Hospital, Suzhou, Jiangsu China
| | - Futing Ji
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Yalan Dou
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
| | - Xiao-jing Hu
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, Shanghai, China
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3
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Lin M, Deming R, Wolfe J, Cummings C. Infant mode of death in the neonatal intensive care unit: A systematic scoping review. J Perinatol 2022; 42:551-568. [PMID: 35058594 DOI: 10.1038/s41372-022-01319-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterize literature that describes infant mode of death and to clarify how limitation of life-sustaining treatment (LST) is defined and rationalized. STUDY DESIGN Eligible studies were peer-reviewed, English-language, and included number of infant deaths by mode out of all infant deaths in the NICU and/or delivery room. RESULT 58 included studies were primarily published in the last two decades from North American and European centers. There was variation in rates of infant mode of death by study, with some showing an increase in deaths following limitation of LST over time. Limitation of LST was defined by the intervention withheld/withdrawn, the relationship between the two practices, and prior frameworks. Themes for limiting LST included diagnoses, low predicted survival and/or quality of life, futility, and suffering. CONCLUSION Limitation of LST is a common infant mode of death, although rates, study definitions, and clinical rationale for this practice are variable.
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Affiliation(s)
- Matthew Lin
- Boston Children's Hospital, Division of Newborn Medicine, Boston, MA, USA.
| | - Rachel Deming
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care and Department of Pediatrics, Boston Children's Hospital, Boston, USA
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care and Department of Pediatrics, Boston Children's Hospital, Boston, USA
| | - Christy Cummings
- Boston Children's Hospital, Division of Newborn Medicine, Boston, MA, USA
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Xu Y, Zhu X, Wang H, Pan Z, Li X, Guo X, Yue H, Sun B. Prevalence of major morbidities and outcome of all hospitalized neonates. A retrospective cohort study of Huai'an neonatal survivals. J Matern Fetal Neonatal Med 2022; 35:9800-9810. [PMID: 35341440 DOI: 10.1080/14767058.2022.2054320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Reliable data for causal implication of neonatal survival in China are lacking. We assumed that by analyzing surviving data of in-hospital neonatal care based on all livebirths in Huai'an, prevalence of neonatal morbidity, mortality and causal relations may be derived comprehensively. MATERIALS AND METHODS Data of all regionally hospitalized neonates were retrospectively linked with corresponding whole livebirths (59,056) in 2015 as a cohort. Diagnoses of diseases and causes of deaths were redefined and categorized. Disease patterns, prevalence of morbidities, case-fatality rate (CFR), and cause-specific mortality rate (CSMR) referring to livebirths were presented. Perinatal and disease-specific risks of death were estimated by multivariable logistic regression. RESULTS In 7,960 (134.8‰) hospitalized patients, 168 (2.1%) died in hospital (2.85‰ of livebirths). Prevalence of major morbidities were 76.8‰ hyperbilirubinemia, 57.4‰ pneumonia, 32.7‰ intraventricular hemorrhage, 20.7‰ sepsis, 20.2‰ birth asphyxia, 9.69‰ congenital anomalies (CA), and 5.30‰ respiratory distress syndrome (RDS). The CFR (CSMR) of major diseases were 30.4% (0.12‰) meconium aspiration syndrome, 17.6% (0.22‰) necrotizing enterocolitis, 14.1% (0.75‰) RDS, 9.09% (0.88‰) CA, 5.26% (0.07‰) bronchopulmonary dysplasia, 1.71% (0.36‰) sepsis and 1.51% (0.31‰) asphyxia. Overall mortality rates were 4.6% and 6.8% in the preterm and low birthweight, and >50% in those of <28 week gestation or <1000 g birthweight, respectively. Mortality risks associated with the perinatal and neonatal morbidities were markedly declined with variable magnitude by multivariable regression models. CONCLUSIONS The in-hospital neonatal survival datafile, depicted as the prevalence of major morbidities and CSMR of livebirth population in Huai'an, denoted overall and specific quality and efficiency of the perinatal-neonatal care system. Its concept and methodology should be relevant, and outcome extrapolated, to other countries or domestic regions, with similar socioeconomic development.
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Affiliation(s)
- Yaling Xu
- The National Commission of Health Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoqin Zhu
- Unit of Population Health Information, Huai'an Women and Children's Hospital, Huai'an, China
| | - Hui Wang
- Unit of Population Health Information, Huai'an Women and Children's Hospital, Huai'an, China
| | - Zhaojun Pan
- Department of Neonatology, Huai'an Women and Children's Hospital, Huai'an, China
| | - Xiaoqiong Li
- Department of Obstetrics, Huai'an Women and Children's Hospital, Huai'an, China
| | - Xiaojing Guo
- The National Commission of Health Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hongni Yue
- Unit of Population Health Information, Huai'an Women and Children's Hospital, Huai'an, China.,Department of Neonatology, Huai'an Women and Children's Hospital, Huai'an, China
| | - Bo Sun
- The National Commission of Health Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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Elfarargy MS, Abu-Risha S, Al-Ashmawy G, Khattab H. Serum vitamin A levels as a novel predictor for respiratory distress syndrome in neonates: is it beneficial? Endocr Metab Immune Disord Drug Targets 2021; 22:235-240. [PMID: 34548005 DOI: 10.2174/1871530321666210921120258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neonatal respiratory distress syndrome (RDS) is a very important dangerous disease in neonates and is accompanied by neonatal complications and death. OBJECTIVE Early determination of neonatal serum vitamin A levels as a possible novel predictor for neonatal RDS. PATIENTS AND METHODS A case-control study, with the identification number TCTR20210206001 was done on 100 neonates who were admitted to the neonatal intensive care unit (NICU) of Tanta University Hospital (TUH) suffering from RDS (patient group) and 100 healthy neonates (control group). Estimation of serum vitamin A (retinol) was occurred for all neonates of this study within the first four hours after birth before any nutrition or therapies. RESULTS Showed no significant difference between serums retinol (RT) levels in grade 1&2 RDS neonates (patient group) and the serum RT levels in the control group while there was significant difference between serums retinol levels in grade 3&4 RDS neonates (patient group) and the serum retinol levels in the control group where the P-value was 0.006, 0.002 respectively. CONCLUSION Serum vitamin A levels in neonates were decreased in RDS neonates and could be used as a predictor for the development and severity of RDS. RECOMMENDATION Routine estimation of serum vitamin A levels in neonates as a novel predictor for neonatal RDS.
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Affiliation(s)
| | - Sally Abu-Risha
- Department of pharmacology& toxicology, faculty of Pharmacy, Tanta University. Egypt
| | - Ghada Al-Ashmawy
- Department of Biochemistry, Faculty of Pharmacy, Tanta University. Egypt
| | - Haidy Khattab
- Department of Physiology, Faculty of Medicine, Tanta University. Egypt
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6
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Ma S, Wu L, Yu Q, Chen D, Geng C, Peng H, Yu L, Zhang M. Associations Between Trajectory of Different Blood Pressure Components in Pregnancy and Risk of Adverse Birth Outcomes - A Real World Study. Risk Manag Healthc Policy 2021; 14:3255-3263. [PMID: 34393532 PMCID: PMC8360358 DOI: 10.2147/rmhp.s318956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background High blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study. Material and Methods Leveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package “traj” in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO. Results Trajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17–20 weeks of gestation for all blood pressure components. Conclusion Our study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.
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Affiliation(s)
- Shengqi Ma
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Lei Wu
- Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China
| | - Qing Yu
- Department of Gynecology and Obstetrics, Suzhou Kowloon Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Donghui Chen
- Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China
| | - Chunsong Geng
- Department of Gynecology and Obstetrics, Suzhou Kowloon Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Lugang Yu
- Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China
| | - Mingzhi Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
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Connolly M, Phung L, Farrington E, Scoullar MJL, Wilson AN, Comrie-Thomson L, Homer CSE, Vogel JP. Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review. Asia Pac J Public Health 2021; 33:489-501. [PMID: 34165364 DOI: 10.1177/10105395211026099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.
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Affiliation(s)
- Mairead Connolly
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Laura Phung
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Elise Farrington
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | - Michelle J L Scoullar
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | | | - Liz Comrie-Thomson
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Ghent University, Ghent, Belgium
| | | | - Joshua P Vogel
- Burnet Institute, Melbourne, Australia.,University of Melbourne, Parkville, Victoria, Australia
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8
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Jiang S, Huang X, Zhang L, Han J, Yang Y, Wang W, Lee SK, Yan W, Cao Y. Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China. JAMA Netw Open 2021; 4:e2113197. [PMID: 34137828 DOI: 10.1001/jamanetworkopen.2021.13197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A significant proportion of very preterm infants (<32 weeks' gestation) are discharged against medical advice (DAMA) from neonatal intensive care units in China. There is minimal information available on the potential outcomes of providing complete care before discharge in these infants. OBJECTIVE To describe potential neonatal outcomes of DAMA in very preterm infants if they receive complete care based on estimates derived from a group of propensity score-matched infants who are not DAMA. DESIGN, SETTING, AND PARTICIPANTS This cohort study enrolled all infants born at between 24 and 31 weeks' gestation from May 1, 2015, to April 30, 2018, and admitted to 25 tertiary neonatal intensive care units across China within 7 days of birth. A multilevel mixed-effects logistic regression model was constructed to estimate the propensity score for the likelihood of DAMA for each infant. Infants who were not DAMA were then matched to DAMA infants with the closest propensity score on a 1:1 ratio by using a nearest neighbor greedy matching algorithm without replacement. Incidences of neonatal outcomes were then calculated among the matched non-DAMA infants to simulate the outcomes of DAMA infants. Statistical analyses were performed from August 16, 2020, to September 26, 2020. EXPOSURES Discharge against medical advice, which was defined as termination of treatment and discharge before the treating physicians recommended discharge. MAIN OUTCOMES AND MEASURES Survival and survival without major morbidity. RESULTS The study enrolled a total of 14 083 infants (8141 boys [57.8%]) with a median gestational age of 30.1 weeks (interquartile range [IQR], 29.0-31.1 weeks) and a median birth weight of 1400 g (IQR, 1170-1600 g). Overall, 1876 of 14 083 very preterm infants (13.3%; 95% CI, 12.8%-13.9%) were DAMA, of whom 1367 of 1876 (72.9%; 95% CI, 70.8%-74.8%) required intensive care on discharge. A total of 1473 DAMA infants were successfully matched to 1473 non-DAMA infants. Overall, 1211 of 1473 matched non-DAMA infants (82.2%; 95% CI, 80.2%-84.1%) survived to discharge. The survival rates were 68.3% (95% CI, 62.4%-73.7%) for infants at 26 to 27 weeks' gestation, 84.1% (95% CI, 80.7%-87.0%) for infants 28 to 29 weeks' gestation, and 92.4% (95% CI, 90.0%-94.2%) for infants at 30 to 31 weeks' gestation. A total of 872 of 1473 matched non-DAMA infants (59.2%; 95% CI, 56.7%-61.7%) survived without any major morbidity. CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that very preterm infants who are DAMA from neonatal intensive care units may have intact survival if complete care is provided. Efforts to reduce DAMA may be associated with improved outcomes of very preterm infants in China.
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Affiliation(s)
- Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiangyuan Huang
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Junyan Han
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Yang
- National Health Commission, Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Weiping Wang
- National Health Commission, Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- 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, Ontario, Canada
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Marinelli KC, Lyden ER, Peeples ES. Clinical risk factors for the development of late-onset circulatory collapse in premature infants. Pediatr Res 2021; 89:968-973. [PMID: 32492694 DOI: 10.1038/s41390-020-0990-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants may be at risk for late-onset circulatory collapse (LCC) where otherwise stable infants develop hypotension resistant to vasoactive agents. The risk factors for LCC development are poorly defined, and it has been theorized that it may be in part due to withdrawal from exogenous prenatal steroids. The goal of this study was to define the clinical characteristics of LCC and investigate its association with antenatal steroid administration. METHODS This is a retrospective cohort study of infants born ≤1500 g. LCC was retrospectively diagnosed in infants requiring glucocorticoids for circulatory instability at >1 week of life. Demographic and clinical characteristics were compared between groups using Mann-Whitney test. RESULTS Three hundred and ten infants were included; 19 (6.1%) developed LCC. Infants with LCC were born at a median 4.6 weeks' lower gestation, 509 g lower birth weight than those without LCC. There was no difference in antenatal steroid delivery between the groups. CONCLUSIONS LCC occurs in a distinct subset of VLBW infants, suggesting the need for monitoring in this high-risk population. Antenatal steroids did not significantly increase the risk of LCC development in this study. IMPACT Late-onset circulatory collapse (LCC) is a life-threatening clinical entity occurring in around 6% in VLBW infants and is likely underdiagnosed in the United States. Targeting specific demographic characteristics such as birth weight (<1000 g) and gestational age at birth (<26 weeks) may allow for early identification of high-risk infants, allowing close monitoring and prompt treatment of LCC. No significant association was found between antenatal steroid administration and LCC development, suggesting that the theoretical risks of antenatal steroids on the fetal HPA axis does not outweigh the benefits of antenatal steroids in fetal lung maturity. To date, no studies characterizing LCC have originated outside of Asia. Therefore, providing a description of LCC in a U.S.-based cohort will provide insight into both its prevalence and presentation to inform clinicians about this potentially devastating disorder and foster early diagnosis and treatment. This study validates LCC characteristics and prevalence previously outlined by Asian studies in a single-center U.S.-based cohort while also identifying potential risk factors for LCC development. This manuscript will provide education for U.S. physicians about the risk factors and clinical presentation of LCC to facilitate early diagnosis and treatment, potentially decreasing neonatal mortality. With prompt recognition and treatment of LCC, infants may have decreased exposure to vasoactive medications that have significant systemic effects.
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Affiliation(s)
| | - Elizabeth R Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
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Pan S, Jiang S, Lin S, Lee SK, Cao Y, Lin Z. Outcome of very preterm infants delivered outside tertiary perinatal centers in China: a multi-center cohort study. Transl Pediatr 2021; 10:306-314. [PMID: 33708516 PMCID: PMC7944173 DOI: 10.21037/tp-20-232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To describe the incidence of outborns among very preterm infants (VPIs, <32 weeks of gestation) in Chinese perinatal centers and to examine the association of outborn status with adverse outcomes. METHODS A cohort study enrolling all VPIs admitted to 18 perinatal centers in China from May 1st, 2015 to April 30th, 2018. Neonatal outcomes including rates of discharge against medical advice (DAMA), in-hospital mortality, overall mortality, severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and severe retinopathy of prematurity (ROP) were compared between outborn and inborn infants. A multivariate logistic regression model was used to estimate the independent association of outborn status with neonatal outcomes. RESULTS Among 12,014 VPIs, 1,991 (16.6%) infants were outborn. Outborn infants had lower Apgar scores and higher illness severity score on admission. Mothers of outborn infants were less likely to receive antenatal steroids, prenatal care and caesarean section. The incidence of DAMA (18.0% vs. 12.5%, P<0.001), overall mortality (19.9% vs. 15.8%, P<0.001) and severe brain injury (10.8% vs. 9.1%, P=0.024) of outborn infants were significantly higher than inborn infants. Outborn status was independently associated with increased risks of DAMA (aOR, 1.6; 95% CI: 1.4-1.8), overall-hospital mortality (aOR, 1.3; 95% CI: 1.1-1.5) and severe IVH/PVL (aOR, 1.2; 95% CI: 1.0-1.5). CONCLUSIONS The incidence of outborn VPIs was high in China. Outborn infants were more likely to be delivered in an uncontrolled situation and were at significantly higher risk of neonatal mortality and severe brain injury compared with inborn infants. Quality improvement efforts are needed to facilitate in-utero transfer of high-risk pregnancies to tertiary centers.
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Affiliation(s)
- Shulin Pan
- Department of Neonatology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Su Lin
- Department of Neonatology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,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, Ontario, Canada
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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11
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Mengistu BA, Yismaw AE, Azene ZN, Mihret MS. Incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia: prospective follow up study. BMC Pediatr 2020; 20:142. [PMID: 32238144 PMCID: PMC7110778 DOI: 10.1186/s12887-020-02031-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Globally, about 2.7 million neonates die annually and more than 99% of these deaths happened in developing countries. Although most neonatal deaths are preventable and attempts had been taken to tackle these deaths, an aggregate of 30 neonatal deaths per 1000 live births had been reported in Ethiopia. In this regard, identifying the predictors could be an important step. However, evidence on the incidence and predictors of neonatal mortality has been limited in Ethiopia, in the study area in particular. Even the available studies were limited in scope and were retrospective or cross section in nature. Thus, this study is aimed at assessing the incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia.. METHOD A multi center prospective follow up study was conducted on 612 neonates admitted in Amhara region referral hospitals from July 01 to August 30, 2018. A simple random sampling technique was used to select three of all referral hospitals in the study settings and all neonates admitted in the selected hospitals were included. Data were entered into Epi info version 7.0 and exported to STATA 14.0 for analysis. Cox proportional hazard regression model was fitted to identify predictors of neonatal mortality. Crude and Adjusted hazard ratio with 95% confidence interval was computed and variables' statistical significance was declared based on its AHR with 95% CI and p-value ≤0.05. RESULT Overall, 144 (18.6%) neonates died with a total person-time of 4177.803 neonate-days which is equivalent to the neonatal mortality rate of 186 per 1000 admitted neonates with 95% CI (157,219). The incidence rate of neonatal mortality was 27 per 1000 admitted neonates with 95%CI (23, 33). Maternal age ≥ 35 years (AHR = 2.60; 95%CI: 1.44, 4.72), mothers unable to read and write (AHR = 1.40; 95%CI: 1.23, 2.44), multiple pregnancy (AHR = 3.96; 95%CI: 2.10, 7.43) and positive maternal HIV status (AHR = 6.57; 95%CI: 2.53, 17.06) were predictors of neonatal mortality. CONCLUSION In this study, the neonatal mortality rate was higher than the national figure. Its most predictors were found to be modifiable. Thus, the stakeholders would better consider the aforementioned predictors to decrease this higher burden.
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Affiliation(s)
- Banchigizie Adane Mengistu
- Teda Health Science College, Amhara Regional Health Bureau, Department of Midwifery, Po. Box 196, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Jiang S, Yan W, Li S, Zhang L, Zhang Y, Shah PS, Shah V, Lee SK, Yang Y, Cao Y. Mortality and Morbidity in Infants <34 Weeks' Gestation in 25 NICUs in China: A Prospective Cohort Study. Front Pediatr 2020; 8:33. [PMID: 32117838 PMCID: PMC7031923 DOI: 10.3389/fped.2020.00033] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/22/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives: To describe the rates and variability of mortality and morbidity of preterm infants born in China. Methods: This prospective cohort study included infants born at <34 weeks' gestation and admitted to 25 NICUs within 7 days of birth between May 1st, 2015 and April 30th, 2016. Infants were followed until death or NICU discharge. The primary outcome was a composite of mortality or any major morbidity (sepsis, necrotizing enterocolitis, intraventricular/periventricular leukomalacia, retinopathy of prematurity, and bronchopulmonary dysplasia) in infants who received complete care following medical advice. Secondary outcomes included rate of discharge against medical advice, mortality and individual morbidities. Results: Of the 8,065 infants, 6,852 (85%) received complete care and 1,213 (15%) were discharged against medical advice. Among infants who received complete care, the rate of the composite outcome was 27% (1,827/6,852), mortality 4% (248/6,852), sepsis 14% (990/6,852), necrotizing enterocolitis 3% (191/6,550), intraventricular hemorrhage/periventricular leukomalacia 7% (422/6,307), retinopathy of prematurity 2% (67/3,349), and bronchopulmonary dysplasia 9% (616/6,852). There were significant variations between NICUs for all outcomes. Conclusions: Discharged against medical advice, mortality, and morbidity rates for preterm infants <34 weeks' gestation are high in China with significant variations between NICUs.
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Affiliation(s)
- Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Shujuan Li
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China
| | - Prakesh S Shah
- Maternal-Infant Care Research Centre and Department of Pediatrics Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vibhuti Shah
- Maternal-Infant Care Research Centre and Department of Pediatrics Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yi Yang
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Chen F, Huang F, Zhan F. Correlation between serum transforming growth factor β1, interleukin-6 and neonatal respiratory distress syndrome. Exp Ther Med 2019; 18:671-677. [PMID: 31258705 PMCID: PMC6566086 DOI: 10.3892/etm.2019.7585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/03/2019] [Indexed: 12/23/2022] Open
Abstract
Trend and correlation of transforming growth factor β1 (TGF-β1) and interleukin-6 (IL-6) in serum of children with neonatal respiratory distress syndrome (NRDS) were investigated. A total of 75 NRDS children born in the Xiangyang Central Hospital from July 2015 to August 2017 were analyzed retrospectively. A total of 45 NRDS premature infants who received pulmonary surfactant (PS) within 12 h after birth were treated as PS group, 30 who did not receive PS treatment as non-PS group, and 32 premature infants without NRDS in the same period were selected as control group. Serum levels of TGF-β1 and IL-6 were detected by enzyme linked immunosorbent assay (ELISA) at various time points after birth and their correlation was analyzed. The expression level of TGF-β1 in serum of children in PS group was significantly higher than that in control group on days 1 and 3 after birth (P<0.05). The expression level of TGF-β1 in non-PS group increased continuously with the increase of number of days and was significantly higher than that in control group on days 1, 3 and 7 after birth (P<0.05), and significantly higher than that in PS group on days 3 and 7 after birth (P<0.05). The analysis of the correlation between the severity of the disease and the expression levels of TGF-β1 and IL-6 showed that the expression levels were elevated with the increase of the disease severity. The expression levels of TGF-β1 and IL-6 were positively correlated with severity of the disease (r=0.7509, P<0.05; r=0.8056, P<0.05). The expression levels of TGF-β1 and IL-6 in PS and non-PS groups were positively correlated (r=0.9042, P<0.05; r=0.8905, P<0.05). The results showed that serum TGF-β1 and IL-6 were elevated in NRDS children, and there was a positive correlation between them.
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Affiliation(s)
- Feng Chen
- Department of Pediatrics, Xiangyang Central Hospital, Affiliated of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Fang Huang
- Department of Pediatrics, Xiangyang Central Hospital, Affiliated of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Fei Zhan
- Department of Pediatrics, Xiangyang Central Hospital, Affiliated of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
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