Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across...

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Autores principales:	Ruimiao Bai, Siyuan Jiang, Jinzhen Guo, Shanyu Jiang, Shoo K. Lee, Zhankui Li, Yun Cao
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	preterm infants discharge against medical advice intraventricular hemorrhage periventricular leukomalacia bronchopulmonary dysplasia necrotizing enterocolitis Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/9092dc3b59f8411a82bbea555c990179
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spelling	oai:doaj.org-article:9092dc3b59f8411a82bbea555c9901792021-11-11T13:12:02ZVariation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study2296-236010.3389/fped.2021.760646https://doaj.org/article/9092dc3b59f8411a82bbea555c9901792021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.760646/fullhttps://doaj.org/toc/2296-2360Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions.Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions.Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China.Ruimiao BaiSiyuan JiangSiyuan JiangJinzhen GuoShanyu JiangShoo K. LeeShoo K. LeeShoo K. LeeZhankui LiYun CaoYun CaoFrontiers Media S.A.articlepreterm infantsdischarge against medical adviceintraventricular hemorrhageperiventricular leukomalaciabronchopulmonary dysplasianecrotizing enterocolitisPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	preterm infants discharge against medical advice intraventricular hemorrhage periventricular leukomalacia bronchopulmonary dysplasia necrotizing enterocolitis Pediatrics RJ1-570
spellingShingle	preterm infants discharge against medical advice intraventricular hemorrhage periventricular leukomalacia bronchopulmonary dysplasia necrotizing enterocolitis Pediatrics RJ1-570 Ruimiao Bai Siyuan Jiang Siyuan Jiang Jinzhen Guo Shanyu Jiang Shoo K. Lee Shoo K. Lee Shoo K. Lee Zhankui Li Yun Cao Yun Cao Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
description	Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions.Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions.Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China.
format	article
author	Ruimiao Bai Siyuan Jiang Siyuan Jiang Jinzhen Guo Shanyu Jiang Shoo K. Lee Shoo K. Lee Shoo K. Lee Zhankui Li Yun Cao Yun Cao
author_facet	Ruimiao Bai Siyuan Jiang Siyuan Jiang Jinzhen Guo Shanyu Jiang Shoo K. Lee Shoo K. Lee Shoo K. Lee Zhankui Li Yun Cao Yun Cao
author_sort	Ruimiao Bai
title	Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
title_short	Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
title_full	Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
title_fullStr	Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
title_full_unstemmed	Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study
title_sort	variation of neonatal outcomes and care practices for preterm infants <34 weeks' gestation in different regions of china: a cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/9092dc3b59f8411a82bbea555c990179
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Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

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