학술논문
Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study.
Document Type
Academic Journal
Author
Boo NY; Population Medicine, Universiti Tunku Abdul Rahman - Kampus Bandar Sungai Long, Kajang, Selangor, Malaysia.; Chee SC; Paediatrics, Hospital Selayang, Batu Caves, Selangor, Malaysia.; Neoh SH; Paediatrics, Tunku Azizah Hospital, Kuala Lumpur, Federal Territory, Malaysia.; Ang EB; Paediatrics, Hospital Sultanah Bahiyah, Alor Setar, Kedah Darul Aman, Malaysia.; Ang EL; Paediatriccs, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia.; Choo P; Paediatrics, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia.; Ahmad Kamar A; Paediatrics, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.; Syed-Abdullah FI; Paediatrics, Tunku Azizah Hospital, Kuala Lumpur, Federal Territory, Malaysia.; Wong AC; Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
Source
Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101715309 Publication Model: eCollection Cited Medium: Internet ISSN: 2399-9772 (Electronic) Linking ISSN: 23999772 NLM ISO Abbreviation: BMJ Paediatr Open
Subject
Language
English
Abstract
Objectives: To determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.
Design: Retrospective cohort study.
Setting: 43 Malaysian neonatal intensive care units.
Patients: 29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.
Main Outcome Measures: Care practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).
Results: During this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C-35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.
Conclusion: Survival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.
Competing Interests: Competing interests: No, there are no competing interests.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Design: Retrospective cohort study.
Setting: 43 Malaysian neonatal intensive care units.
Patients: 29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.
Main Outcome Measures: Care practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).
Results: During this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C-35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.
Conclusion: Survival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.
Competing Interests: Competing interests: No, there are no competing interests.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)