Outcome of very preterm infants delivered outside tertiary perinatal centers in China: a multi-center cohort study

Pan, Shulin; Jiang, Siyuan; Lin, Su; Lee, Shoo K.; Cao, Yun; Lin, Zhenlang

doi:10.21037/tp-20-232

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…Maternal diabetes and hypertension included any type of these diseases that occur before or during pregnancy. Inborn was defined as a preterm infant born in a perinatal center ( 24 ). Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age and sex ( 25 ).…”

Section: Methodsmentioning

confidence: 99%

Impact of maternal age on neonatal outcomes among very preterm infants admitted to Chinese neonatal intensive care units: a multi-center cohort study

Qi¹,

Wang²,

Lin³

et al. 2022

Transl Pediatr

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Background The percentage of advanced maternal age (aged over 35 years) mothers has been rising across the world, the evidence of maternal age on neonatal outcomes from low- and middle-income countries is scarce. Our objective was to evaluate the effect of maternal age on mortality and major morbidity among very preterm infants admitted to Chinese neonatal intensive care units. Methods Data from a retrospective multi-center cohort of all complete care very preterm infants admitted to 57 neonatal intensive care units that participated in the Chinese Neonatal Network from January 1st to December 31st, 2019 were analyzed. Neonatal outcomes including mortality or any major morbidity, defined as necrotizing enterocolitis stage 2 or 3, moderate & severe bronchopulmonary dysplasia, severe intraventricular hemorrhage, cystic periventricular leukomalacia, severe retinopathy of prematurity, or sepsis. A multiple logistic regression model was constructed to analyze the independent association between maternal age and neonatal outcome. Results Among 7,698 eligible newborns, 80.5% of very preterm infants were born to mothers between the ages of 21 and 35 years, with 18.0% born to mothers >35 years and 1.5% born to mothers <21 years. Higher rates of maternal hypertension, maternal diabetes, cesarean deliveries, antenatal steroid usage were noted as maternal age increased. The proportion of prenatal care, cesarean section, antenatal steroid usage and inborn for very preterm infants born to mothers <21 years was lower than those of mothers of other ages. Compared to the ages of 21–35 years group, the odds of severe intraventricular hemorrhage (adjusted odd ratio: 2.00, 95% CI: 1.08–3.71) was significantly higher in the ages of 15–20 years group. Increasing maternal age was associated with higher rates of small for gestational age and lower birth weight of very preterm infants, but no correlation between advanced maternal age and very preterm infants mortality or major morbidity. Conclusions Among very preterm infants, increasing maternal age was associated with higher rates of small for gestational age but not neonatal mortality or major morbidity. Young maternal age may increase the risk of severe intraventricular hemorrhage of very preterm infants.

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Section: Methodsmentioning

confidence: 99%

Impact of maternal age on neonatal outcomes among very preterm infants admitted to Chinese neonatal intensive care units: a multi-center cohort study

Qi¹,

Wang²,

Lin³

et al. 2022

Transl Pediatr

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Impact of quality improvement outreach education on the incidence of acute brain injury in transported neonates born premature

et al. 2022

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A Care-bundle to Prevent Germinal Matrix–Intraventricular Hemorrhage in Neonates

The LAYA Group of the Global Newborn Society,

Ayad

2024

Newborn

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Germinal matrix-intraventricular hemorrhages (GM-IVHs) can be seen in up to 25-30% of premature infants. These are associated with a major psychological, social, and financial challenge for care-providers and families caring for premature infants all over the world. The severity is usually classified based on the location and volume vis-à-vis that of the cerebral ventricles, including (A) Grade I GM-IVHs localized in the germinal matrix; (B and C) Grade II and III hemorrhages occupying less than and more than 50% of the ventricular cavities, respectively; and (D) Grade IV IVHs that extend into the surrounding parenchyma with/without a periventricular hemorrhagic infarction (PVH). Germinal matrix-intraventricular hemorrhages have been associated with impaired neurodevelopment (17.5%), static physical disabilities in cerebral palsy (7-63%), deafness (8.6%), and blindness (2.2%). Considering the complex etiopathogenesis of GM-IVH and the fact that most of these events occur within a temporally-delimited period of the first 72 hours after birth, there is increasing interest in the structured application of 3-5 well-accepted preventive measures as a quality improvement (QI) "care bundle" during the high-risk period. In this article, we have described the evidence on which our GM-IVH bundle is based. We have carefully evaluated antenatal factors such as the history of having received steroids and magnesium sulfate, perinatal measures such as delayed cord clamping, management of thrombocytopenia and/or coagulopathy, and postnatal measures such as maintaining a midline head position, cautious endotracheal suctioning and blood withdrawals, and avoidance of routine flushing of intravenous and arterial lines. Based on the strongest evidence and practice consensus, we have adopted a 4-point bundle to prevent GM-IVH in premature infants: (A) Appropriate neonatal resuscitation with, if possible, delayed cord clamping; (B) Golden-hour care; (C) Gentle care of outborn infants including safe transport and avoiding hemodynamic instability; and (D) if needed, management of perinatal thrombocytopenia and coagulopathy. In the next 3-5 years, we will report compliance and changes in the incidence/severity of GM-IVH at our centers.

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Outcome of very preterm infants delivered outside tertiary perinatal centers in China: a multi-center cohort study

Cited by 3 publications

References 31 publications

Impact of maternal age on neonatal outcomes among very preterm infants admitted to Chinese neonatal intensive care units: a multi-center cohort study

Impact of maternal age on neonatal outcomes among very preterm infants admitted to Chinese neonatal intensive care units: a multi-center cohort study

Impact of quality improvement outreach education on the incidence of acute brain injury in transported neonates born premature

A Care-bundle to Prevent Germinal Matrix–Intraventricular Hemorrhage in Neonates

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