| ObjectiveExtremely premature infants(EPIs)and/or extremely low birth weight infants(ELBWIs)have a high mortality and morbidity rate.This study analyzed the changes in survival rate,morbidity rate,and cause of death of neonatal EPIs and/or ELBWIs of Shandong Provincial Hospital from 2010 to 2019 longitudinally;conducted horizontal multicenter analysis of EPIs and/or ELBWIs from 2018 to 2019 for the recent outcomes and causes of death,exploring the bottlenecks restricting the survival of EPI and/or ELBWI,and providing a clinical basis for further improving.MethodsMaternal characteristics,perinatal information,neonatal characteristics,treatment information and final outcomes and the cause of death of EPI and/or ELBWI admitted to NICU from January 1,2010 to December 31,2015 was collected retrospective,relevant case data from January 1,2016 to December 31,2019 was prospectively collected.The changes in treatment measures and outcomes over time compare,and divided into two stages(2010?2015 and 2016?2019),for analyzing and comparing the causes of death,risk factors of death,time of death and the occurrence of complications during hospitalization of survivors;the Ningbeixin neonatal homogenization collaborative research platform(http://www.ningbx.com/index/login/login.html)was established in 2018,32 neonatal intensive care units(NICU)established a regional multi-center premature infant prognosis evaluation collaboration group-Shandong Neonatal Network(SNN),prospectively collected from January 1,2018 to 2019 EPI and/or ELBWI case data on December 31,2015,the mode of death was classified into three types:maximal intensive care,redirected intensive care,and withdrawal of care due to socioeconomic reasons,and maximal intensive care,redirected intensive care were classified as treatment-ineffective deaths for analyzing the causes of death and conduct univariate analysis and multi-factor logistic risk factors analysis,and discuss the bottlenecks that restrict the survival of EPI and/or ELBWI.ResultsA total of 398 patients were included in this study during the 10-year period from 2010 to 2019.The overall survival rate was 66.1%,the lowest survival rate was 26.3%in 2012,and the highest survival rate was 89.7%in 2018.A total of 141 patients were enrolled in the first phase of the study,and a total of 257 patients were enrolled in the second phase of the study.The death rate for withdrawal of care in the second phase compared with the first phase decreased from 24.8%to 6.2%.35 patients died in the first stage of treatment-ineffective.The causes of death were RDS(n=10),IVH(n=8),sepsis(n=5),BPD(n=4),severe asphyxia(n=4),NEC(n=1),extremely immature development(n=1);33 patients died in the second stage of treatment-ineffective,the cause of death was sepsis(n=9),RDS(n=7),IVH(n=4),BPD(n=4),NEC(n=3),extremely immature development(n=3),severe asphyxia(n=2).The second stage is significantly less than the early death after the first stage.In addition to small gestational age,low birth weight,5-minute Apgar score<7 points,from 2010 to 2015,early postnatal hypoglycemia(OR=13.691,95%C1:1.259,148.840),pulmonary hemorrhage(OR=27.073,95%C1:2.011,364.428)was independent risk factors for death;while in 2016?2019,moderate/severe hypothermia(OR=4.450,95%Cl:1.676,11.818),early onset sepsis(EOS)(OR=2.535,95%C1:1.033,6.222),pulmonary hemorrhage(OR=4.450,95%C1:1.676,11.818)were independent risk factors for death.Compared with the 2010?2015 stages,the survival rate in the second stage and the incidence of serious complications during hospitalization of survivors both increased.After adjusting for gestational age,SGA,and gender,the survival rate still increased significantly(AOR=7.285,95%C1:7.235,12.533),the incidence of ROP at stage 3 and above or requiring treatment is significantly reduced(AOR=0.170,95%C1:0.051,0.565),while severe BPD,NEC in stage 3 or in need of treatment,IVH/PVL in stage 3 or above increase was not statistically significant.A total of 772 patients with EPI and/or ELBWI were included in the multicenter,505 patients(65.4%)survived,102 patients(13.2%)died after active treatment,36 patients(4.7%)died after redirected treatment,and 138 patients died of ineffective treatment(17.9%),129 patients(16.7%)died after giving up treatment.Among the deaths after withdrawal of care,the main reason for giving up treatment was fear of prognosis(73.1%),and 15.6%was due to economic reasons.The leading causes of death for treatment-ineffective death were sepsis(n=38),RDS(n=25),IVH(n=23),severe asphyxia(n=18),NEC(n=14),and extremely immature development(N=9),BPD(n=7).Deaths within 1 day were most due to RDS,severe asphyxia and extremely immature.Deaths due to sepsis happened within 2-7 days mostly,followed by RDS and severe asphyxia,and the deaths due to sepsis were still the most during 8-14 days,followed by IVH;NEC was the main cause of death within 14-28 days.deaths>29 days were mainly caused by BPD and IVH.In addition to smaller gestational age and lower birth weight,multiple births(AOR=1.725,95%C1:1.079,2.758),moderate to severe hypothermia(AOR=1.593,95%C1:1.018,2.494),EOS(AOR=7.912,95%C1:1.238,2.952),neonatal pulmonary hemorrhage(AOR=3.154,95%C1:1.805,5.513),NEC in stages 2-3(AOR=4.145,95%Cl:1.449,11.864)are the independent risk factors for death.For 505 survivors,severe complications during hospitalization,severe BPD,grade 3 or higher IVH/PVL,NEC requiring surgery,stage 3 and above or ROP requiring treatment were 40(7.9%)and 40(7.9%),6(1.2%),44(8.7%).ConclusionThe 10-year data from a single center shows that the survival rate of EPI and/or ELBWI,especially the success rate of treatment,has gradually increased,and was close to the international level,which closely related to the improvement of the diagnosis and treatment process and the establishment of a single center database;the success rate of treatment had reached more than 65%at the age of 25 weeks or more;perinatal factors such as intrauterine infection and hospital admission hypothermia are the main factors that cause for death in EPI and/or ELBWI;The composition of deaths due to withdrawal of care and treatment-ineffective deaths was basically the same.Insufficient confidence in treatment and concerns about sequelae were the main reasons for parents giving up treatment;the main morbidity of survivors during hospitalization still have a certain incidence.It is necessary to pay attention to the follow-up after discharge of this group and pay attention to their long-term health.development. |
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