The National Commission of Health Laboratory of Neonatal Diseases; National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Department of Neonatology, Huai'an Women and Children's Hospital, Huai'an, Jiangsu, China.
BMC Pregnancy Childbirth. 2022 Apr 19;22(1):338. doi: 10.1186/s12884-022-04653-8.
Current vital statistics of birth population and neonatal outcome in China lacked information and definition of deaths at delivery and during hospitalization, especially for extreme preterm (EPT) birth. This study aims to delineate the prevalence of neonatal hospitalization, neonatal and infant mortality rates (NMR, IMR) and associated perinatal risks based on all livebirths in Huai'an, an evolving sub-provincial region in eastern China.
This retrospective cohort study established a comprehensive database linking information of whole regional livebirths and neonatal hospitalization in 2015, including deaths at delivery and EPT livebirths. The primary outcomes were NMR and IMR stratified by gestational age (GA) and birthweight (BW) with 95% confidence intervals. Causes of the neonatal and infant deaths were categorized according to the International Statistical Classification of Diseases 10th version, and population attributable fractions of GA and BW strata were analyzed. Perinatal risks of infant mortalities in continuum periods were estimated by Cox regression models.
Among the whole livebirth population (59056), 7960 were hospitalized (prevalence 13.5%), with 168 (2.8‰) in-hospital deaths. The NMR was 3.6 (3.2, 4.1)‰ and IMR 4.9 (1.4, 4.5)‰, with additionally 35 (0.6‰) deaths at delivery. The major causes of infant deaths were perinatal conditions (2.6‰, mainly preterm-related), congenital anomalies (1.5‰), sudden unexpected death in infancy (0.6‰) and other causes (0.2‰). The deaths caused by preterm and low BW (LBW) accounted for 50% and 40% of NMR and IMR, with 20-30% contributed by EPT or extremely LBW, respectively. Multivariable Cox regression analysis revealed that peripartum factors and LBW strata had strong association with early- and late-neonatal deaths, whereas those of GA < 28 weeks were highly associated with postneonatal deaths. Congenital anomalies and neonatal hospitalization remained high death risks over the entire infancy, whereas maternal co-morbidities/complications were modestly associated with neonatal but not postneonatal infant mortality.
The NMR, IMR, major causes of deaths and associated perinatal risks in continuum periods of infancy, denote the status and quality improvement of the regional perinatal-neonatal care associated with socioeconomic development. The study concept, applicability and representativeness may be validated in other evolving regions or countries for genuine comparison and better maternal-infant healthcare.
中国目前的出生人口和新生儿结局的生命统计数据缺乏分娩时和住院期间死亡的信息和定义，尤其是极早产儿（EPT）出生。本研究旨在根据中国东部一个不断发展的副省级地区淮安市的所有活产儿，描述新生儿住院、新生儿和婴儿死亡率（NMR、IMR）以及相关围产期风险的流行情况。
本回顾性队列研究建立了一个综合数据库，将整个地区的活产儿和 2015 年新生儿住院信息（包括分娩时和 EPT 活产儿的死亡情况）联系起来。主要结局是按胎龄（GA）和出生体重（BW）分层的 NMR 和 IMR，并给出 95%置信区间。新生儿和婴儿死亡的原因根据国际疾病分类第 10 版进行分类，并分析了 GA 和 BW 分层的人群归因分数。通过 Cox 回归模型估计婴儿死亡的连续时期围产期风险。
在全活产儿人群（59056 人）中，有 7960 人住院（患病率为 13.5%），其中 168 人（2.8‰）住院期间死亡。NMR 为 3.6（3.2，4.1）‰，IMR 为 4.9（1.4，4.5）‰，另有 35 例（0.6‰）分娩时死亡。婴儿死亡的主要原因是围产期情况（2.6‰，主要与早产有关）、先天畸形（1.5‰）、婴儿猝死（0.6‰）和其他原因（0.2‰）。由早产和低体重（LBW）引起的死亡占 NMR 和 IMR 的 50%和 40%，分别有 20-30%由 EPT 或极低 LBW 引起。多变量 Cox 回归分析显示，围产期因素和 LBW 分层与早、晚期新生儿死亡密切相关，而 28 周以下 GA 与新生儿后死亡密切相关。先天畸形和新生儿住院仍是整个婴儿期高死亡风险，而母亲合并症/并发症与新生儿但不与新生儿后婴儿死亡率相关。
新生儿死亡率、婴儿死亡率、死亡的主要原因以及与婴儿期连续时期相关的围产期风险，反映了与社会经济发展相关的区域围产儿-新生儿护理的状况和质量的改善。该研究概念、适用性和代表性可在其他不断发展的地区或国家进行验证，以便进行真实的比较和更好的母婴保健。
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