Mortality and Morbidity in Infants <34 Weeks' Gestation in 25 NICUs in China: A Prospective Cohort Study

Siyuan Jiang; Weili Yan; Shujuan Li; Lan Zhang; Yi Zhang; Prakesh S Shah; Vibhuti Shah; Shoo K Lee; Yi Yang; Yun Cao

doi:10.3389/fped.2020.00033

Mortality and Morbidity in Infants <34 Weeks' Gestation in 25 NICUs in China: A Prospective Cohort Study

Front Pediatr. 2020 Feb 13:8:33. doi: 10.3389/fped.2020.00033. eCollection 2020.

Authors

Siyuan Jiang¹, Weili Yan², Shujuan Li¹, Lan Zhang¹, Yi Zhang², Prakesh S Shah^{3

4}, Vibhuti Shah^{3

4}, Shoo K Lee^{3

4

5}, Yi Yang⁶, Yun Cao¹

Affiliations

¹ Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
² Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.
³ Maternal-Infant Care Research Centre and Department of Pediatrics Mount Sinai Hospital, Toronto, ON, Canada.
⁴ Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁵ Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China.

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.

Keywords: China; morbidity; mortality; outcome; preterm infants.