Mortality of neonatal respiratory failure from Chinese northwest NICU network

Abstract

Objectives: We aimed to evaluate the efficacy of respiratory support and surfactant in incidence, management and outcome of neonatal hypoxemic respiratory failure (NRF) in Chinese emerging regional neonatal–perinatal care system in the era of universal health insurance policy.

Study design: Clinical data of NRF were prospectively collected in 12 consecutive months from 2011 to 2012 in 12 neonatal intensive care units (NICU) in major cities of Northwest China. NRF was defined as hypoxemia requiring nasal continuous positive airway pressure (nCPAP) or intratracheal ventilation combined with surfactant for at least 24 h, with associated risk factors, mortality rate and major co-morbidities analyzed.

Results: Among 9816 admissions, there were 1324 NRF cases with 60.2% being preterm. The incidence of NRF was 13.4% with a mortality of 15.5%. The major underlying diseases were respiratory distress syndrome (RDS, 38.9%) and pneumonia/sepsis (38.0%). Only 15.9% of NRF and 33.8% of RDS received surfactant, which contributed to >70% and >85% survival in RDS patients of birth weight (BW) < 1500 g and >1500 g, respectively. Multivariate logistic regression analysis showed that premature rupture of membrane ≥ 24 h, very low BW and gestational age < 32 weeks, resuscitation at delivery, illness severity at admission, intratracheal ventilation and sepsis were the independent risk factors for the mortality of NRF. The length and cost of NICU stay for survivors reflected care burden in the era of universal health insurance.

Conclusions: Surfactant significantly improved the survival of neonates with NRF and RDS, reflecting the respiratory care standard in emerging regional neonatal–perinatal care network with limited resources.

Keywords:

• Epidemiology
• mortality
• neonate
• prematurity
• respiratory distress syndrome
• respiratory failure
• respiratory therapy
• surfactant

Acknowledgments

Authors are grateful to Dr. Ying Dong for English editing and revision of the manuscript, to Drs. Runsheng Ge, Liming He and Yaling Xu from Children’s Hospital of Fudan University for data collection, and to all the staffs from participating NICUs for their generous and supportive collaboration.

Declaration of interest

The authors have no financial and non-financial conflict of interest to disclose. This study was supported in part by the Project 211 (phase III), Ministry of Education; the Project for Institutional Development in Laboratory of Neonatal Medicine, National Health and Family Planning Commission; and Shanghai Municipal Department of Health (No. LJ06038).

Supplementary material available online.