| Objective Since the establishment of neonatology, preterm infants have been the focus of this subject. Wether in newborn or in-patient babies, premature accounts for the main position. The incidence of preterm infants is rising now in most countries all over the world, with the advances in medical technology and the changes of social, economic, and environmental factors. The gestational age of birth, birth weight and disease spectrum in preterm infants has changed during these years. Previous methods or techniques of empirical diagnostic and treatment cannot meet these rapid variations, all the clinical strategies should be made adapted to these changes. How can we learn about the current status of premature quickly and accurately, a collaborative network of national newborns has been established which is relied on the computer network technology by using the successful experience of Canada, the United States and Europe countries. In order to study the epidemiology of preterm infants in China, we analyzed10498cases from106078newborns of52hospitals in23provinces through the neonatal database and network.Methods (1) Preparation work:We connected with other units in neonatal network and reached a consensus on how the network runs.(2) The registration form of neonatal clinical data was designed first.(3) The establishment of national neonatal database was based on the registration form. After tested the comprehensiveness of the form and the compliance of the registration work, we modified the registration form and database software according to the outcome of pre-survey. When the final edition of the registration form and database was confirmed, we notified the network units to expand the scale of data collection.(4) Data collection:106078infants who were born in the units of the neonatal network from May1st2010to December31st2011were enrolled in the study. The registrations were completed when the newborns discharged from the hospital, health information about the newborns at home will been recorded as supplement.(5) Data processing and analysis:A retrospective research was made in this database. Statistical analyses were performed in this database.Results (1) The general information:The majority of the95297patients were full-term newborns in neonatal database. Gestational age was38.64±1.97week(range 22～43w), birth weight was3219.66±551.506g (range265-6790g).(2) Basic characteristics:The incident of preterm infants was9.90%(n=10498), gestational age was34.1±2.1week.The min GA was22week. Birth weight was2315.65±590.63g(range265g～5200g).(3) Maternal history:there were9448women who gave birth to preterm infants.63.26%(n=8110) mothers’ age was between20to35years old. Only79.47%(n=7509) mothers had regular prenatal care.2.49%(n=262) premature babies were created by ART or drugs which can promote ovulation. Pregnancy induced hypertension, intrauterine infections, gestational diabetics and ICP accounted for the most common diseases during pregnancy。And the preterm had the higher incidence of maternal diseases (p<0.001).66.26%preterm infants of GA less than34wk received antenatal dexamethasone treatment. The preterm infants of PIH history had the higher incidence of asphyxia and HIE (p<0.001).50.25%(n=5275) infants was delivered by cesarean section.29.71%(n=3119) babies existed PROM.19.53%(n=2050) infants were multiple birth.6.02%(n=632) premature had fetal distress.12.79%(n=1343) at1min postnatal age and4.94%(n=519) at5min postnatal age had an Apgar score less than7. We found that ART, intrauterine infections, PROM, multiple birth and PIH were risk factors of preterm birth through logistic regression analysis.(4) Manifestation:The major symptoms of preterm infants in the neonatal database were jaundice (36.10%), dyspnea (25.10%), cyanosis (12.35%), anemia (6.32%), deformity(4.89%), abdominal distension (2.31%), vomiting (1.47%) and fever (1.04%).(5) Disease spectrum:There were hyberbilirubinemia (36.43%, n=3825), asphyxia (13.08%, n=1374), RDS(9.02%, n=947), infectious pneumonia (8.67%, n=911), fetal distress(6.02%, n=632), preterm anemia(5.66%,n=595), intracranial hemorrhage(5.62%, n=590), hypoglycemia(5.50%, n=578), aspiratory pneumonia(5.23%, n=550), congenital heart disease(5.07%, n=533) among the highest incidence of neonatal diseases. Respiratory diseases (29.22%, n=3067) and infectious diseases (20.09%, n=2110) played important roles in premature diseases, the incidence of these two diseases is higher in preterm infants than in term infants(P<0.001). The variation of Disease spectrum is followed the change of the GA and birth weight in premature.(6) Treatment:21.99%(n=2308) were admitted to NICU.27.10%(n=2845) were given TPN.20.06%(n=2106)was given oxygen,8.30%(n=871) were treated with CPAP,5.01%(n=526) with ventilator,4.66%(n=489) were given PS therapy.27.48%(n=2885) were treated with phototherapy.8.91%(n=935) were given antibiotic.3.05%(n=320) got blood products.(7) Prognosis:The overall length of stay was9.18±9.64d (range1-372d). A negative correlation was been proved between GA and birth weight with hospital stay. Premature mortality (4.12%) was higher than total mortality (1.37%) in the neonatal database (P<0.001).64.12%(n=277) preterm babies died in3days after being born.The death causes of preterm infants in neonatal database were asphyxia, RDS, infectious pneumonia, congenital malformation.Conclusions (1) The incident of preterm infants in China increased annually.(2) ART, intrauterine infections, PROM, multiple birth and PIH were risk factors of preterm birth in this survey.(3) Hyperbilirubinemia, respiratory diseases, neurological diseases and infectious diseases listed top4among all the preterm diseases.(4) Gestational age and birth weight of premature are highly associated with the length of stay, disease spectrum, treatment and prognosis.(5) Resuscitation techniques of premature are very important. Respiratory support occupied a very important position in preterm therapy, especially oxygen inhalation, CPAP and mechanical ventilation.(6) The Mortality rate of premature played important roles in neonatal death. Most preterm babies died in3days after being born. The death causes of preterm infants in neonatal database were asphyxia, RDS, infectious pneumonia, congenital malformation.(7) This study suggests that the establishment of neonatal clinical database is feasible and it do help studying the epidemiology, outcomes and health services of neonates which can improve efficacy and efficiency of neonatal care. |
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