BackgroundThe outcome of preterm infants has been varied in different hospitals and regions in developing countries. Regular clinical monitor are needed to know the effects of health care. This study aimed to describe the survival and morbidity rates of extreme to very preterm infants in 15 neonatal-intensive care hospitals in China.MethodsData were collected from January 1, 2013 to December 31, 2014 for preterm neonates with gestational age (GA) between 24 and 31 complete weeks born in hospitals from our collaborative study group. The primary outcomes were survival and major morbidities prior to hospital discharge. Major morbidities included bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis. Mutivariate logistic regression was used to analyze the risk factor influencing on the outcomes.ResultsThe preterm birth rate was 9.9 % (13 701/138 240). The proportion of extreme to very preterm infants was 1.1 % and 11.8 % respectively. The survival rate prior to discharge was increased with increasing GA (0, 24 weeks; 28 %, 25 weeks; 84.8 %, 26 weeks; 83.5 %, 27 weeks; 87.4 %, 28 weeks; 90.7 %, 29 weeks; 93.9 %, 30 weeks; 96 %, 31 weeks). Rate of survival and without severe morbidity according to GA were 0 at 24 weeks, 8 % at 25 weeks, 60.6 % at 26 weeks; 53.2 % at 27 weeks; 62.3 % at 28 weeks; 67.9 % at 29 weeks; 79.1 % at 30 weeks, 85.8 % at 31 weeks respectively. Rate of antenatal steroid use was 56 %. The antenatal steroid use was lower in GA < 28 weeks infants than that in GA between 28 and 32 weeks (28–44.3 % vs 49.7–60.1 %, P < 0.05). Infants at the lowest GAs had a highest incidence of morbidities. Overall, 58.5 % had respiratory distress syndrome, 12.5 % bronchopulmonary dysplasia, 3.9 % necrotizing enterocolitis, 15.4 % intraventricular hemorrhage, 5.4 % retinopathy of prematurity, 28.4 % patent ductus arteriosus, and 9.7 % sepsis. Mortality and morbidity were influenced by gestational age (OR = 0.891, 95 % CI: 0.796–0.999, p = 0.0047 and OR = 0.666, 95 % CI: 0.645–0.688, p = 0.000 respectively), birth weight (OR = 0.520, 95 % CI: 0.420–0.643, p = 0.000 and OR = 0.921, 95 % CI: 0.851–0.997, p = 0.041 respectively), SGA (OR = 1.861, 95 % CI: 1.148–3.017, p = 0.012 and OR = 1.511, 95 % CI: 1.300–1.755, p = 0.000 respectively), Apgar score <7 at 5 min (OR = 1.947, 95 % CI: 1.269–2.987, p = 0.002 and OR = 2.262, 95 % CI: 1.950–2.624, p = 0.000 respectively). The survival rate was increased with more prenatal steroid use (OR = 1.615, 95 % CI: 1.233–1.901, p = 0.033).ConclusionAlthough most of the preterm infants with GAs ≥26 weeks survived, a high complication in survivors still can be observed. Rate of survival of GAs less than 26 weeks was still low, and quality improvement methods should be used to look into increasing the use of antenatal steroids in the very preterm births.

Objective  Maternal mortality ratio (MMR) in Shanghai residents has been declining in the past two decades and has reached levels comparable to developed countries. The MMR in migrating population in Shanghai remains high, however. The objectives of this study were to compare the trends of MMR between residents and migrating population in Shanghai from 1996 to 2005 and to explore the reasons for the dramatic differences in MMR between the two groups living in the same city. Design  Retrospective cohort study. Setting  Shanghai, China. Population  A total of 902 807 pregnancies with live births in Shanghai in the period of 1996–2005. Methods  We first compared the overall MMR between migrating population and permanent residents in Shanghai and examined temporal trends of MMR in the two subpopulations. We then compared the causes and maternal characteristics of maternal deaths between the two subpopulations. Main outcome measures  Maternal mortality and cause of death. Results  A total of 902 807 live births and 243 maternal deaths were recorded in Shanghai in the period of 1996 to 2005, with an average MMR of 26.66 per 100 000 live births. The MMR in Shanghai residents declined dramatically from 22.47 per 100 000 in 1996 to 1.64 per 100 000 live births in 2005 (P < 0.01), while the MMR in migrating population was reduced only moderately from 54.68 per 100 000 live births to 48.46 per 100 000 (P > 0.05). The main causes of maternal deaths in migrating population were postpartum haemorrhage (39.9%), pregnancy‐induced hypertension (9.8%), and puerperal infection (9.3%), whereas the main causes of maternal death of Shanghai residents were chronic heart and liver diseases (20.0%), postpartum haemorrhage (12.9%), and amniotic fluid embolism (12.9%). Among the maternal death cases in migrating women, 60% had elementary education or less, 22% were unemployed, 65% had no prenatal visit, 44% gave a birth at home, and 12% of the deaths occurred at home. Conclusion  Lack of access to quality maternity care, especially for the effective management of postpartum haemorrhage, is the main reason for the high MMR in migrating population in Shanghai.

Background Now, in China, injury has been become the leading cause of death of children aged 0–14 instead of malnutrition and infectious diseases. Each year, it is estimated that at least 10 million children have been harmed by the various injuries, 100 000 children death and 400 000 children disabled. Objective To study the status of child injure in Tongzhou district of Beijing for providing scientific basis on injury prevention and control. Methods Injury surveillance data of three hospitals in Tongzhou district from 2006 to 2010 were collected and analysed. Results A total of 4855 child injury cases were collected, including 3177 boys (65.42%) and 1679 girls (34.58%). The most frequent time of injury occurrence was June and July in 1 year, and at 10:00 in 1 day. The five main causes of injury were falls (37.72%), animal injury (29.26%), blunt injury (12.68%), non-motor vehicle accident (6.45%) and knife/sharp injury (6.22%). The majority of injuries happened in home (49.42%), schools (25.58%), roads (14.68%), public places (6.49%) and sport facilities (1.69%). Upper limbs (35.61%), lower limbs (32.33%) and heads (23.54%) were injured more frequently than other parts of the body. The most of the injuries are unintentional, minor injuries. Significance It is suggested to take intervention programmes against different child injuries and increase the publicity of injury in families and schools to improve the supervision of parents and the whole society.