Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018

Liu, Yuxi; Kang, Lakhwinder Singh; He, Chunhua; Miao, Lei; Qiu, Xiaoqiong; Xia, Weipeng; Zhu, Jun; Liang, Juan; Li, Qi; Wang, Yanping; Liu, Hanmin

doi:10.1136/bmjopen-2020-042654

Cited by 26 publications

(26 citation statements)

References 18 publications

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“…Moreover, preterm birth is the most common cause of neonatal death. 49 From the perspectives of society and family loss, the burden of preterm birth in China is substantial. The Chinese Government's strategic investments in maternal and neonatal health have partly contributed to the prevention of preterm birth.…”

Section: Discussionmentioning

confidence: 99%

Preterm births in China between 2012 and 2018: an observational study of more than 9 million women

Deng

Liang

et al. 2021

The Lancet Global Health

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126

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Summary Background Preterm birth rates have increased significantly worldwide over the past decade. Few epidemiological studies on the incidence of preterm birth and temporal trends are available in China. This study used national monitoring data from China's National Maternal Near Miss Surveillance System (NMNMSS) to estimate the rate of preterm birth and trends between 2012 and 2018 in China and to assess risk factors associated with preterm birth. Methods In this observational study, data were sourced from the NMNMSS between Jan 1, 2012, and Dec 31, 2018. Pregnancies with at least one livebirth, with the baby born at 28 weeks of gestation or more or 1000 g or more birthweight were included. We estimated the rates of overall preterm, very preterm (born between 28 and 31 weeks’ gestation), moderate preterm (born between 32 and 33 weeks’ gestation), and late preterm (born between 34 and 36 weeks’ gestation) births in singleton and multiple pregnancies and assessed their trends over time. We used logistic regression analysis to examine the associations between preterm birth and sociodemographic characteristics and obstetric complications, considering the sampling strategy and clustering of births within hospitals. Interrupted time series analysis was used to assess the changes in preterm birth rates during the period of the universal two child policy intervention. Findings From Jan 1, 2012, to Dec 31, 2018, 9 645 646 women gave birth to at least one live baby, of whom 665 244 (6·1%) were born preterm. In all pregnancies, the overall preterm birth rate increased from 5·9% in 2012 to 6·4% in 2018 (8·8% increase; annual rate of increase [ARI] 1·3 [95% CI 0·6 to 2·1]). Late preterm births (8·8%; ARI 1·5% [0·9 to 2·2]) and very preterm births (13·3%; ARI 1·8% [0·5 to 3·0]) significantly increased from 2012 to 2018, whereas moderate preterm births did not (3·8%; ARI 0·3% [95% CI –0·9 to 1·5]). In singleton pregnancies, the overall preterm birth rate showed a small but significant 6·4% increase (ARI 1·0% [0·4 to 1·7]) over the 7 year period. In multiple pregnancies, the overall preterm birth rate significantly increased from 46·8% in 2012 to 52·7% in 2018 (12·4% increase; ARI 1·9% [1·2 to 2·6]). Compared with women who gave birth in 2012, those who gave birth in 2018 were more likely to be older (aged ≥35 years; 7·4% in 2012 vs 15·9% in 2018), have multiples (1·6% vs 1·9%), have seven or more antenatal visits (50·2% vs 70·7%), and have antepartum complications and medical disease (17·9% vs 35·1%), but they were less likely to deliver via caesarean section (47·5% vs 45·0%). Compared with the baseline period (January, 2012 to June, 2016), a higher increase in preterm birth was observed after the universal two child policy came into effect in July, 2016 (β=0·034; p=0·03). Interpretation ...

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Section: Discussionmentioning

confidence: 99%

Preterm births in China between 2012 and 2018: an observational study of more than 9 million women

Deng

Liang

et al. 2021

The Lancet Global Health

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126

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“…Baroni et al [ 7 ] investigated the neonatal mortality rates in Brazil, whereas Liu et al [ 8 ] and Abdul-Mumin et al [ 9 ] investigated the key reasons for neonatal death and preterm birth in China and Ghana. Regional investigations have identified that preterm birth, intrapartum complications and pneumonia (in case of China), and preterm birth complications and birth asphyxia (in case of Ghana) are the leading causes of neonatal deaths [ 8 , 9 ]. On a global scale, the major causes of neonatal death include preterm birth, severe infections and asphyxia [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous researchers have mostly considered a single outcome variable; in some cases, two variables were considered to examine the association between maternal obesity with other variables of interest, including miscarriage, stillbirth [ 4 ] and neonatal death [ 8 , 9 ]. In contrast, this research has taken a holistic approach to compare and contrast how maternal obesity is related to pre and post-birth maternal and neonatal risk factors by including multiple outcome variables together.…”

Section: Introductionmentioning

confidence: 99%

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries

et al. 2021

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Background Obesity prevalence is increasing in many countries in the world, including Asia. Maternal obesity is highly associated with fetal and neonatal deaths. This study investigated whether maternal obesity is a risk factor of fetal death (measured in terms of miscarriage and stillbirth) and neonatal mortality in South and South-East Asian countries. Methods This cross-sectional study pooled the most recent Demographic and Health Surveys (DHS) from eight South and South-East Asian countries (2014–2018). Multivariate logistic regression was deployed to check the relationships between maternal obesity with fetal and neonatal deaths. Finally, multilevel logistic regression model was employed since the DHS data has a hierarchical structure. Results The pooled logistic regression model illustrated that maternal obesity is associated with higher odds of miscarriage (adjusted odds ratio [aOR]: 1.26, 95% CI: 1.20–1.33) and stillbirths (aOR: 1.46, 95% CI: 1.27–1.67) after adjustment of confounders. Children of obese mothers were at 1.18 (aOR: 1.18, 95% CI: 1.08–1.28) times greater risk of dying during the early neonatal period than mothers with a healthy weight. However, whether maternal obesity is statistically a significant risk factor for the offspring’s late neonatal deaths was not confirmed. The significant association between maternal obesity with miscarriage, stillbirth and early neonatal mortality was further confirmed by multilevel logistic regression results. Conclusion Maternal obesity in South and South-East Asian countries is associated with a greater risk of fetal and early neonatal deaths. This finding has substantial public health implications. Strategies to prevent and reduce obesity should be developed before planning pregnancy to reduce the fetal and neonatal death burden. Obese women need to deliver at the institutional facility centre that can offer obstetrics and early neonatal care.

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“…We found that preterm infants admitted to NICUs in eastern China were at the lowest risks of death, whereas infants in western China had the highest mortality. Several studies have reported a similar disparity of maternal, child, and neonatal mortality from eastern to western China (1)(2)(3)(20)(21)(22)(23). Overall, inadequate health service infrastructures and low health expenditure due to less developed economic status are thought to have resulted in inequity in neonatal and child health in the western region (2,23).…”

Section: Discussionmentioning

confidence: 98%

Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

et al. 2021

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Background: To compare outcomes and care practices of preterm infants born at <34 weeks' gestation in the different regions of China from 2015 to 2018.Methods: This cohort study enrolled all infants born at <34 weeks and admitted to 25 tertiary neonatal intensive care units across China from May 1st, 2015, to April 30th, 2018. The participating hospitals were categorized into three groups according to their distinct geographic locations: eastern China, central China, and western China. Multilevel mixed-effects logistic regression models were used to assess the independent association between neonatal outcomes and regions.Results: A total of 27,532 infants at <34 weeks' gestation were enrolled in our study. Overall, 14,178 (51.5%) infants were from 12 hospitals in eastern China, 8,069 (29.3%) from 9 hospitals in central China, and 5,285 (19.2%) from 4 hospitals in western China. Infants in eastern China had the lowest rates of mortality or any morbidity (23.3%), overall mortality (7.6%), in-hospital mortality (3.7%), and discharge against medical advice (DAMA, 6.3%), compared with central (27.8, 11.3, 5.0, and 10.6%, respectively) and western China (37.4, 19.4, 7.7, and 19.4%, respectively). Multilevel mixed-effects logistic regression showed that infants in western China were exposed to the highest risks of mortality or any morbidity, overall mortality, in-hospital mortality, and DAMA. Significant variations of care practices existed in three regions. Infants in central China had the longest duration of the first course of invasive ventilation, the lowest rate of continuous positive airway pressure within 24 h after birth, the lowest rate of breast milk feeding, the latest initiation of feeds, and the longest duration of total parenteral nutrition among the three regions.Conclusions: We identified marked disparities in outcomes and clinical care practices of preterm infants born at <34 weeks' gestation in different regions of China. Targeted quality improvement efforts are needed to improve the outcomes of premature infants in different regions of China.

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Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018

Cited by 26 publications

References 18 publications

Preterm births in China between 2012 and 2018: an observational study of more than 9 million women

Preterm births in China between 2012 and 2018: an observational study of more than 9 million women

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries

Variation of Neonatal Outcomes and Care Practices for Preterm Infants <34 Weeks' Gestation in Different Regions of China: A Cohort Study

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