Chee Y Y, Wong M Sc, Wong R Ms, Wong K Y
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
Hong Kong Med J. 2017 Aug;23(4):381-6. doi: 10.12809/hkmj166064. Epub 2017 Jul 7.
There is a paucity of local data on neonatal outcomes of preterm/very-low-birth-weight infants in Hong Kong. This study aimed to evaluate the survival rate on discharge and morbidity of preterm/very-low-birth-weight infants (≤29+6 weeks and/or birth weight <1500 g) over a decade at Queen Mary Hospital in Hong Kong, so as to provide centre-specific data for prenatal counselling and to benchmark these results against the Vermont Oxford Network.
Standardised perinatal/neonatal data were collected for infants with gestational age of 23+0 to 29+6 weeks and/or birth weight of <1500 g who were born at Queen Mary Hospital between 1 January 2005 and 31 December 2014. These data were compared with all neonatal centres in the Vermont Oxford Network in 2013. The Chi squared test was used to compare the categorical Queen Mary Hospital data with that of Vermont Oxford Network. A two-tailed P value of <0.05 was considered statistically significant.
The overall survival rate on discharge from Queen Mary Hospital for 449 infants was significantly higher than that of the Vermont Oxford Network (87% versus 80%; P=0.0006). The morbidity-free survival at Queen Mary Hospital (40%) was comparable with the Vermont Oxford Network (44%). At Queen Mary Hospital, 86% of infants had respiratory distress syndrome, 40% bronchopulmonary dysplasia, 44% patent ductus arteriosus, 7% severe intraventricular haemorrhage, 5% necrotising enterocolitis, 10% severe retinopathy of prematurity, 10% late-onset sepsis, and 84% growth failure on discharge. Rates of respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis, and severe retinopathy of prematurity were similar in the two populations. At Queen Mary Hospital, significantly more infants had bronchopulmonary dysplasia (P=0.011), patent ductus arteriosus (P=0.015), and growth failure (P=0.0001) compared with the Vermont Oxford Network. In contrast, rate of late-onset sepsis was significantly lower at Queen Mary Hospital than the Vermont Oxford Network (P=0.0002).
Mortality rate and most of the morbidity rates of our centre compare favourably with international standards, but rates of bronchopulmonary dysplasia and growth failure are of concern. A regular benchmarking process is crucial to audit any change in clinical outcomes after implementation of a local quality improvement project.
香港缺乏关于早产/极低出生体重儿新生儿结局的本地数据。本研究旨在评估香港玛丽医院十年来早产/极低出生体重儿（孕周≤29 + 6周和/或出生体重<1500克）的出院存活率和发病率，以便为产前咨询提供特定中心的数据，并将这些结果与佛蒙特牛津网络进行对比。
收集了2005年1月1日至2014年12月31日在玛丽医院出生的孕周为23 + 0至29 + 6周和/或出生体重<1500克的婴儿的标准化围产期/新生儿数据。这些数据与2013年佛蒙特牛津网络中的所有新生儿中心的数据进行了比较。采用卡方检验将玛丽医院的分类数据与佛蒙特牛津网络的数据进行比较。双侧P值<0.05被认为具有统计学意义。
玛丽医院449例婴儿的总体出院存活率显著高于佛蒙特牛津网络（87%对80%；P = 0.0006）。玛丽医院的无发病存活率（40%）与佛蒙特牛津网络（44%）相当。在玛丽医院，86%的婴儿患有呼吸窘迫综合征，40%患有支气管肺发育不良，44%患有动脉导管未闭，7%患有重度脑室内出血，5%患有坏死性小肠结肠炎，10%患有重度早产儿视网膜病变，10%患有晚发性败血症，84%的婴儿出院时存在生长发育迟缓。两个群体中呼吸窘迫综合征、脑室内出血、坏死性小肠结肠炎和重度早产儿视网膜病变的发生率相似。与佛蒙特牛津网络相比，玛丽医院患有支气管肺发育不良（P = 0.011）、动脉导管未闭（P = 0.015）和生长发育迟缓（P = 0.0001）的婴儿明显更多。相比之下，玛丽医院的晚发性败血症发生率显著低于佛蒙特牛津网络（P = 0.0002）。
我们中心的死亡率和大多数发病率与国际标准相比具有优势，但支气管肺发育不良和生长发育迟缓的发生率令人担忧。定期进行基准对比对于审核本地质量改进项目实施后临床结局的任何变化至关重要。
