Outcome of neonatal hypoxemic respiratory failure: a livebirth population-based retrospective survey

Sufang Ding; Yaling Xu; Hui Wang; Hongni Yue; Zhaojun Pan; Bo Sun; Huai’an Perinatal-Neonatal Study Group

doi:10.1186/s12887-022-03603-9

Outcome of neonatal hypoxemic respiratory failure: a livebirth population-based retrospective survey

BMC Pediatr. 2022 Sep 17;22(1):552. doi: 10.1186/s12887-022-03603-9.

Authors

Sufang Ding^#¹, Yaling Xu^#², Hui Wang³, Hongni Yue^{1

3}, Zhaojun Pan⁴, Bo Sun^{5

6}; Huai’an Perinatal-Neonatal Study Group

Collaborators

Huai’an Perinatal-Neonatal Study Group:
Guofang Zheng, Xiaoqin Zhu, Weijie Ding, Xiaoqiong Li, Tingting Qi, Muling Zhang, Zhaofang Tian, Honghua Guan, Juan Yang, Yongjian Wu, Tao Xu, Chunhong Tang, Maotian Dong, Chunhua Zhang, Chunqin Dong, Sumei Zhou, Yani Lei, Shouzhong Li, Keyan Zhu, Xia Zhao, Yaodong Yin, Haijun Wang, Bi Xue, Zhaoxia Wang, Shucheng Wang, Hong Liu, Zhou Xu, Chuntao Yuan, Xihui Cao, Jianya Zhang, Bu Xu, Wenlong Lin, Cui Gao, Yongbo Heng, Lei Wang, Moqing Wang

Affiliations

¹ Department of Neonatology, Huai'an Maternal and Child Health Care Center, Huai'an, 223002, Jiangsu, China.
² The National Commission of Health Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
³ Unit of Population Health Information, Huai'an Maternal and Child Health Care Center, Huai'an, Jiangsu, China.
⁴ Department of Neonatology, Huai'an Maternal and Child Health Care Center, Huai'an, 223002, Jiangsu, China. 1276684451@qq.com.
⁵ The National Commission of Health Laboratory of Neonatal Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China. bsun@shmu.edu.cn.
⁶ Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China. bsun@shmu.edu.cn.

^# Contributed equally.

Abstract

Background: To explore the prevalence, outcome and perinatal risks of neonatal hypoxemic respiratory failure (NRF) in a survey of all livebirths from a regional network of perinatal-neonatal care during the transition period after 5-year universal health insurance implemented in China.

Methods: Clinical data of all neonatal respiratory morbidities in Huai'an were retrospectively collected in the regional perinatal network database of all livebirths as vital statistics in 2015. NRF was defined as hypoxemia requiring continuous positive airway pressure (CPAP) and/or mechanical ventilation (MV) for at least 24 h. Mortality risks of antenatal and perinatal morbidities, major respiratory therapies and complications were analyzed by multivariable logistic regression model.

Results: There were 788 NRF cases identified in 9.9% (7960) hospitalized, or 13.3‰ (59056) livebirths, in which 6.7% received intensive care and 93.0% critical care. The major underlying morbidities were respiratory distress syndrome (RDS, 36.4%) and pneumonia/sepsis (35.3%), treated mainly by CPAP, MV and surfactant. Significantly improved outcomes by surfactant in RDS were in patients with birthweight (BW) < 1500 g or gestational age (GA) < 32 weeks. The overall mortality rate in NRF was 18.4% whereas for those of BW < 1000 g and GA < 28 weeks, 70% and 54%, respectively. The multivariable regression analysis showed the highest odds for NRF death among meconium aspiration syndrome, congenital anomalies, BW < 1500 g and necrotizing enterocolitis, whereas born in level III hospitals, cesarean delivery, CPAP and MV were associated with markedly reduced death odds.

Conclusions: The salient findings with associated risk estimates reflected efficiency of respiratory support as critical care in a prefectural regional network infrastructure for annual livebirths in 5.6 million inhabitants. It implicated the representativeness of contemporaneous perinatal-neonatal care standard at medium to medium-high level, in one/fourth of the population of China, aiming at saving more life of very critical and preterm infants for better survival.

Keywords: Epidemiology; Livebirth; Morbidity; Mortality; Neonate; Respiratory distress syndrome; Respiratory failure; Surfactant; sepsis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Birth Weight
Female
Humans
Infant
Infant, Newborn
Infant, Newborn, Diseases*
Infant, Premature
Meconium Aspiration Syndrome*
Pregnancy
Pulmonary Surfactants* / therapeutic use
Respiratory Distress Syndrome, Newborn* / drug therapy
Respiratory Distress Syndrome, Newborn* / therapy
Respiratory Insufficiency* / drug therapy
Retrospective Studies
Surface-Active Agents / therapeutic use

Substances

Pulmonary Surfactants
Surface-Active Agents