Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore.
Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore.
Pediatr Neonatol. 2023 Sep;64(5):585-595. doi: 10.1016/j.pedneo.2022.12.016. Epub 2023 Mar 15.
Very preterm infants are at risk for neurodevelopmental impairment because of postnatal morbidities. This study aims to (1) compare the outcomes of very-low-birth-weight (VLBW) infants in Singapore during two time periods over a decade; 2) compare performances among Singaporean neonatal intensive care units (NICUs); and 3) compare a Singapore national cohort with one from the Australian and New Zealand Neonatal Network (ANZNN).
Singapore national data on VLBW infants born during two periods, 2007-2008 (SG2007, n = 286) and 2015-2017 (SG2017, n = 905) were extracted from patient medical records. The care practices and clinical outcomes among three Singapore NICUs were compared using SG2017 data. Third, using data from the ANZNN2017 annual report, infants with gestational age (GA) ≤29 weeks in SG2017 were compared with their Oceania counterparts.
SG2017 had 9.9% higher usage of antenatal steroids (p < 0.001), 8% better survival for infants ≤26 weeks (p = 0.174), and used 12.7% lesser nonsteroidal anti-inflammatory drugs for patent ductus arteriosus closure (p < 0.001) than those of SG2007 cohort. Rate of late-onset sepsis (LOS) was almost halved (7.4% vs. 14.0%, p < 0.001), and exclusive human milk feeding after discharge increased threefold (p < 0.001). SG2017, in contrast, had a higher rate of chronic lung disease (CLD) (20.0% vs. 15.1%, p = 0.098). Within SG2017, the rates of LOS, CLD, and human milk feeding varied significantly between the three NICUs. When compared with ANZNN2017, SG2017 had significantly lower rates of LOS for infants ≤25 weeks (p = 0.001), less necrotizing enterocolitis for infants ≤27 weeks (p = 0.002), and less CLD across all GA groups.
Postnatal morbidities and survival rates for VLBW infants in Singapore have improved over a decade. Outcomes for VLBW infants varied among three Singapore NICUs, which provide a rationale for collaboration to improve clinical quality. The outcomes of Singaporean VLBW infants were comparable to those of their ANZNN counterparts.
早产儿由于出生后的各种并发症，存在神经发育障碍的风险。本研究旨在：(1)比较新加坡在过去十年中的两个时间段内极低出生体重儿(VLBW)的结局；(2)比较新加坡新生儿重症监护病房（NICU）之间的表现；(3)比较新加坡全国队列与澳大利亚和新西兰新生儿网络（ANZNN）的队列。
从患者病历中提取了新加坡在两个时期(2007-2008 年，SG2007，n=286；2015-2017 年，SG2017，n=905)出生的极低出生体重儿(VLBW)的国家数据。使用 SG2017 数据比较了三个新加坡 NICU 的治疗方法和临床结局。第三，使用 ANZNN2017 年度报告的数据，比较了 SG2017 中胎龄(GA)≤29 周的婴儿与其大洋洲同龄儿的情况。
SG2017 产前使用类固醇的比例高 9.9%（p<0.001），26 周以下婴儿存活率提高 8%（p=0.174），用于动脉导管未闭关闭的非甾体类抗炎药减少 12.7%（p<0.001）。晚发性败血症（LOS）的发生率几乎减半（7.4%比 14.0%，p<0.001），出院后完全母乳喂养的比例增加了三倍（p<0.001）。相反，SG2017 的慢性肺病（CLD）发病率较高（20.0%比 15.1%，p=0.098）。在 SG2017 中，三个 NICU 之间的 LOS、CLD 和人乳喂养的发生率差异显著。与 ANZNN2017 相比，SG2017 中≤25 周的婴儿 LOS 发生率显著降低（p=0.001），≤27 周的婴儿坏死性小肠结肠炎发生率显著降低（p=0.002），所有 GA 组的 CLD 发生率均较低。
过去十年中，新加坡极低出生体重儿的围产期并发症和存活率有所提高。新加坡三个 NICU 之间的极低出生体重儿结局存在差异，这为提高临床质量的合作提供了依据。新加坡极低出生体重儿的结局与澳大利亚和新西兰新生儿网络的同龄儿相当。
