A Multi-center Study On Complications And Consequences Of Premature Infants In Henan Province

Background and objectivesIn recent years,premature infants has become a global health problem,and its incidence is increasing year by year.According to the 2019 WHO Global Systematic Assessment of Premature Infant Levels,the incidence of premature infants was 10.6percent globally and 6.9 percent in China.Premature infants and its complications are the leading causes of death among children under 5 years old,accounting for 35 percent of neonatal death worldwide.The younger the gestational age,the lower the birth weight and the higher the mortality rate.With the increase of the survival rate of premature infants,the incidence of nervous system,respiratory system,circulatory system and digestive system sequelae shows a significant uptrend,which brings huge burden to the family and the society as well.Henan Province is one of the most populous provinces in China,and the quality of new born population is directly related to national economy and people’s livelihood.At present,there is still a lack of large sample,multi-center studies on the complications and consequences of premature infants.The aim of this study is to provide a basis for reducing the mortality rate of premature infants and improving the quality of life of premature infants by retrospectively analyzing the major complications,consequences and causes of death of premature infants in Henan Province in 2019.MethodsWe designed The Premature Infant Epidemiology Questionnaire in Henan Province(see attached list),and then stratified cluster sampling was conducted in hospitals in 17 citys in Henan Province.A clinical data of all live-birth preterm infants delivered in obstetrics department from January to December 2019 in 53 hospitals were collected in total.A multicenter retrospective study was conducted to analyze the common complications,outcomes and causes of death of premature infants.SPSS26.0 statistical software was used for data analysis.Results1.General situation of premature infants: A total of 12406 cases of premature infants were admitted in 53 hospitals,and the incidence of premature infants was5.8%(12406/212438).The male to female ratio is 1.26 to 1.The mean gestational age was(34.5±2.3)weeks,and the mean birth weight was(2296.8±607.0)g.2.Complications of premature infants:the most common complication was pneumonia(4881 cases,39.3%),followed by neonatal respiratory distress syndrome(4306cases,34.7%),asphyxia(2108cases,17.0%),patent ductus arteriosus(1675cases,13.5%),septicemia(694cases,5.6%),intraventricular hemorrhage(679cases,5.5%),necrotizing enterocolitis(273cases,2.2%),bronchopulmonary dysplasia(212cases,1.7%),periventricular leukomalacia(197cases,1.6%),retinopathy of prematurity(152cases,1.2%),pulmonary hemorrhage(95 cases,0.8%),cholestasis(93cases,0.8%),pneumothorax(88cases,0.7%),meconium aspiration syndrome(78cases,0.6%),intracranial infection(72cases,0.6%),persistent pulmonary hypertension of the new-born(46 cases,0.4%).Except for pneumothorax,the incidence of complications in preterm infants with different gestational ages was different(P <0.001).The incidence of complications in preterm infants with different birth weights was different.(P < 0.05).3.Consequences: The incidence of improvement,abandonment,death and hospital transfer of premature infants were 93.4%(11588/12406),2.6%(328/12406),0.8%(95/12406)and 3.2%(395/12406)respectively.With the increase of gestational age and birth weight,the improvement rate increased gradually,while the abandonment rate,mortality rate and hospital transfer rate decreased(P<0.001).4.The mortality of preterm infants was mainly distributed in gestational age <32 weeks and birth weight < 1500 g,and 63.2%(n=60)of the deaths occurred within7 days after birth.5.The main causes of death in premature infants were non-infectious diseases of the lung(34.7%),infectious diseases(13.7%),asphyxia(13.7%)and congenital malformation(12.6%).With the increase of gestational age,the proportion of lung non-infectious diseases decreased,and the proportion of congenital malformation and chromosomal diseases/genetic metabolic diseases gradually increased,while infectious diseases always account for a large proportion.Conclusion1.The incidence of premature infants in Henan Province is 5.8%,and the mortality rate is 0.8%,which is in the medium level in China.2.The major complications of premature infants include pneumonia,neonatal respiratory distress syndrome,asphyxia,patent ductus arteriosus,septicemia,etc.Except for pneumothorax,the incidence of complications in premature infants with different gestational age and birth weight was significantly different.3.With the increase of gestational age and birth weight,the improvement rate of premature infants showed an increasing trend,while the mortality showed a decreasing trend.4.Deaths of premature infants mainly occured within 7 days after birth and the main causes were lung non-infectious diseases,infectious diseases,asphyxia and congenital malformation,and it is necessary to strengthen prenatal screening and perinatal health care,and prevent and cure complications actively,so as to improve the poor prognosis of premature infants.