Luo Ningxin, Jiang Siyuan, Cao Yun, Li Shujuan, Han Junyan, Zhou Qi, Li Mengmeng, Guo Jinzhen, Liu Hongyan, Yang Zuming, Ji Yong, Zhang Baoquan, Huang Zhifeng, Yuan Jing, Pan Dandan, Shi Jingyun, Hu Xuefeng, Lin Su, Zhao Qian, Yan Changhong, Wang Le, Wei Qiufen, Kan Qing, Gao Jinzhi, Liu Cuiqing, Jiang Shanyu, Liu Xianghong, Sun Huiqing, Du Juan, He Li, Reduction of Infection in Chinese Neonatal Intensive Care Units Using the Evidence-based Practice for Improving Quality
Abstract
ObjectiveTo investigate the incidence and trend of short-term outcomes among preterm infants born <34 weeks′ gestation.
MethodsA secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study "reduction of infection in neonatal intensive care units (NICU) using the evidence-based practice for improving quality (REIN-EPIQ) study". This study was conducted in 25 tertiary NICU. A total of 27 192 infants with gestational age <34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled. Infants with severe congenital malformation were excluded. Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups. Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years. Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders.
ResultsA total of 27 192 preterm infants were enrolled with gestational age of (31.3±2.0) weeks at birth and weight of (1 617±415) g at birth. Overall, 9.5% (2 594/27 192) of infants were discharged against medical advice, and the overall mortality rate was 10.7% (2 907/27 192). Mortality for infants who received complete care was 4.7% (1 147/24 598), and mortality or any major morbidity was 26.2% (6 452/24 598). The incidences of moderate to severe bronchopulmonary dysplasia, sepsis, severe intraventricular hemorrhage or periventricular leukomalacia, proven necrotizing enterocolitis, and severe retinopathy of prematurity were 16.0% (4 342/27 192), 11.9% (3 225/27 192), 6.8% (1 641/24 206), 3.6% (939/25 762) and 1.5% (214/13 868), respectively. There was a decreasing of the overall mortality (P<0.001) during the 3 years. Also, the incidences for sepsis and severe retinopathy of prematurity both decreased (both P<0.001). However, there were no significant differences in the major morbidity in preterm infants who received complete care during the 3-year study period (P=0.230). After adjusting for confounders, infants admitted during the third study year showed significantly lower risk of overall mortality (adjust OR=0.62, 95%CI 0.55-0.69, P<0.001), mortality or major morbidity, moderate to severe bronchopulmonary dysplasia, sepsis and severe retinopathy of prematurity, compared to those admitted in the first study year (all P<0.05).
ConclusionsFrom 2015 to 2018, the mortality and major morbidities among preterm infants in Chinese NICU decreased, but there is still space for further efforts. Further targeted quality improvement is needed to improve the overall outcome of preterm infants.
Key words:
Intensive care units, neonatal; Infant, premature; Mortality
Contributor Information
Luo Ningxin
Department of Neonatology, Children′s Hospital of Fudan University, National Children′s Medical Center, Shanghai 201102, China
Jiang Siyuan
Department of Neonatology, Children′s Hospital of Fudan University, National Children′s Medical Center, Shanghai 201102, China
Cao Yun
Department of Neonatology, Children′s Hospital of Fudan University, National Children′s Medical Center, Shanghai 201102, China
Li Shujuan
Department of Neonatology, Children′s Hospital of Fudan University, National Children′s Medical Center, Shanghai 201102, China
Han Junyan
National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Children′s Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
Zhou Qi
Department of Neonatology, Children′s Hospital of Fudan University, National Children′s Medical Center, Shanghai 201102, China
Li Mengmeng
Department of Neonatology, Women's Hospital of Nanjing Medical University, Nanjing 210004, China
Guo Jinzhen
Department of Neonatology, Northwest Women′s and Children′s Hospital, Xi′an 200001, China
Liu Hongyan
Department of Neonatology, Maternal and Child Hospital of Hubei Province, Wuhan 430064, China
Yang Zuming
Department of Neonatology, Suzhou Municipal Hospital, Suzhou 215008, China
Ji Yong
Department of Neonatology, Shanxi Children′s Hospital, Taiyuan 030006, China
Zhang Baoquan
Department of Neonatology, Fujian Maternity and Child Health Hospital, Fuzhou 350005, China
Huang Zhifeng
Department of Neonatology, the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University, Shenzhen 518047, China
Yuan Jing
Department of Neonatology, Qingdao Women and Children′s Hospital of Southern Medical University, Qingdao 266011, China
Pan Dandan
Department of Neonatology, Guiyang Maternal and Child Health Care Hospital, Guiyong Children's Hospital, Guiyang 550002, China
Shi Jingyun
Department of Neonatology, Gansu Provincial Maternal and Child-care Hospital, Lanzhou 730050, China
Hu Xuefeng
Department of Neonatology, Shanghai First Maternal and Infant Hospital, Shanghai 201204, China
Lin Su
Department of Neonatology, the 2nd Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou 325088, China
Zhao Qian
Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
Yan Changhong
Department of Neonatology, Jiangxi Provincial Children′s Hospital, Nanchang 330006, China
Wang Le
Department of Neonatology, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, China
Wei Qiufen
Department of Neonatology, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning 530002, China
Kan Qing
Department of Neonatology, Children′s Hospital of Nanjing Medical University, Nanjing 210008, China
Gao Jinzhi
Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
Liu Cuiqing
Department of Neonatology, Children′s Hospital of Hebei Province, Shijiazhuang 050031, China
Jiang Shanyu
Department of Neonatology, Wuxi Maternal and Child Health Care Hospital, Wuxi 214002, China
Liu Xianghong
Department of Neonatology, Children′s Hospital Affiliated to Shandong University, Jinan 250022, China
Sun Huiqing
Division of Neonatology, Children′s Hospital Affiliated to Zhengzhou University, Jinan Children's Hospital, Henan Children′s Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
Du Juan
Department of Neonatology, Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China
He Li
Department of Neonatology, the Third Xiangya Hospital of Central South University, Changsha 410013, China
Reduction of Infection in Chinese Neonatal Intensive Care Units Using the Evidence-based Practice for Improving Quality
