Epidemiological Study And Evaluation Of Neonatal Respiratory Failure In Shenzhen

ObjectiveTo investigate the incidence,mortality,morbidity and therapy of neonatal respiratory failure(NRF) through multicentre prospective study,evaluate risk factors that are associated with NRF death,improve the NRF remedy level and decrease neonatal mortality.Methods18 hospitals with neonatal intensive care unit in Shenzhen were established into NRF collaborative study group.Information on NRF admitted to all participating hospitals during May 1,2008 to March 30,2009 was prospectively collected by trained staffs using a standard case report form.NRF was defined as requiring assisted ventilation including mechanical ventilation or nasal continuous positive airway pressure(nCPAP)＞24 hours,or give-up treatment after parents' decision in 24 hours of receiving assisted ventilation.Patient information included prenatal history,health condition of mother,status of infants and problems at delivery;primary disease, repiratory care,complications,prognosis and disease burden.Shenzhen Children's Hospital was served as a coordinating center in charge of managing the operation of survey and monitoring data quality.Univariate and multiviariate analysis were performed respectively to analyze the risk factors of death in preterm and term infants.ResultsA total of 12080 hospitalized newborns were enrolled and 360 patients developed NRF during May 1,2008 to March 30,2009.The incidence of NRF was 2.98%.The mortality of NRF was 25.8%.Mean gestation age(GA) was 34.5±4.2 weeks,and 67.2%were preterm infants,31.1%were term infant,1.7%were postterm.Mean of birth weight was 2236±846g and 1.1%were BW＞4000g,62.8%were BW＜2500g, 23%were BW＜1500g.Congenital anomalies were found in 27(7.5%) patients.The cause of NRF were respiratory distress syndrome(RDS 52.5%),pulmonary infection (PI 18.1%),meconium aspiration syndrome(MAS 9.2%),Amniotic Fluid Aspiration Pneumonitis(AFAP 6.9%).The most common cause of NRF were RDS with 75.6% and PI with 10.3%in preterm infants,while were PI with 33.1%and MAS with 22%in term infants.③The ratio of treatment with conventional mechanical ventilation (CMV),nasal continuous positive airway pressure(nCPAP) and high-frequency ventilation(HFV) was 49.7%,37.8%and 0.8%respectively in the newborn infants with NRF.④65.6%of the patients with NRF had a full recovery,25.8%of the patients with NRF died,8.1%discharged when the disease getting better.The incidences of complicated pulmonary infection,periventricular-intraventricular hemorrhage,patent ductus arteriosus were 25.8%,13.3%,9.7%,respectively.Logistic regression analysis showed that low birth weight,congenital anomalies,endotracheal intubation during resuscitations and conventional mechanical ventilation were the high risk factors associated with death in preterm infants(OR=2.433,4.322,3.087,2.839,respectively, P＜0.01 ),while were bag-mask ventilation during resuscitations and conventional mechanical ventilation in term infants(OR=4.656,4.523,respectively,P＜0.01 ).ConclusionThe incidence of NRF in Shenzhen based on hospitalized neonate is 2.98%, similar to the study of Italy in 1995.RDS,PI and MAS is the major cause of NRF.②The common complication of the patients with NRF are complicated pulmonary infection and PVH-IVH.③The mortality of NRF was 25.8%,obviously higher than the study of Italy in 1995.The mortality of RDS and MAS is 22.8%,33.4%, respectively,is lower than that reported in China.④High factors independently associated with death in preterm infants are low birth weight,congenital anomalies, endotracheal intubation during resuscitations and conventional mechanical ventilation, while are bag-mask ventilation during resuscitations and conventional mechanical ventilation in term infants.