Use of antenatal corticosteroids among infants with gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study

Background:Antenatal corticosteroids(ACS)can significantly improve the outcomes of preterm infants.This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units(NICU)and to explore perinatal factors associated with ACS use,using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24^(+0)to 31^(+6)weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st,2019 to December 30th,2019.The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery.Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled,among which 6103(78.0%)infants received ACS.ACS use rates increased with increasing gestational age(GA),from 177/259(68.3%)at 24 to 25 weeks’gestation to 3120/3960(78.8%)at 30 to 31 weeks’gestation.Among infants exposed to ACS,2999 of 6103(49.1%)infants received a single complete course,and 33.4%(2039/6103)infants received a partial course.ACS use rates varied from 30.2%to 100%among different hospitals.Multivariate regression showed that increasing GA,born in hospital(inborn),increasing maternal age,maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’gestation admitted to Chinese NICUs,with fewer infants receiving a complete course.The use rates varied significantly among different hospitals.Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.

Status of the neonatal follow‑up system in China:survey and analysis

Background There is little information about neonatal follow-up programs(NFUPs)in China.This study aimed to conduct a survey of hospitals participating in the Chinese Neonatal Network(CHNN)to determine the status of NFUPs,including resources available,criteria for enrollment,neurodevelopmental assessments,and duration of follow-up.Methods We conducted a descriptive study using an online survey of all 72 hospitals participating in CHNN in 2020.The survey included 15 questions that were developed based on the current literature and investigators’knowledge about followup practices in China.Results Sixty-four(89%)of the 72 hospitals responded to the survey,with an even distribution of children’s(31%),maternity(33%)and general(36%)hospitals.All but one(98%)hospital had NFUPs,with 44(70%)being established after 2010.Eligibility criteria for follow-up were variable,but common criteria included very preterm infants<32 weeks or<2000 g birth weight(100%),small for gestational age(97%),hypoxic ischemic encephalopathy(98%)and postsurgery(90%).The average follow-up rate was 70%(range:7.5%–100%).Only 12%of hospitals followed up with patients for more than 24 months.There was significant variation in neurodevelopmental assessments,follow-up schedule,composition of staff,and clinic facilities and resources.None of the staff had received formal training,and only four hospitals had sent staff to foreign hospitals as observers.Conclusions There is significant variation in eligibility criteria,duration of follow-up,types of assessments,staffing,training and facilities available.Coordination and standardization are urgently needed.

Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units

Background This study aimed to describe length of stay(LOS)to discharge and site variations among very preterm infants(VPIs)admitted to 57 Chinese neonatal intensive care units(NICUs)and to investigate factors associated with LOS for VPIs.Methods This retrospective multicenter cohort study enrolled all infants<32 weeks’gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network,within 7 days after birth in 2019.Exclusion criteria included major congenital anomalies,NICU deaths,discharge against medical advice,transfer to non-participating hospitals,and missing discharge date.Two multivariable linear models were used to estimate the association of infant characteristics and LOS.Results A total of 6580 infants were included in our study.The overall median LOS was 46 days[interquartile range(IQR):35-60],and the median corrected gestational age at discharge was 36 weeks(IQR:35-38).LOS and corrected gestational age at discharge increased with decreasing gestational age.The median corrected gestational age at discharge for infants at 24 weeks,25 weeks,26 weeks,27-28 weeks,and 29-31 weeks were 41 weeks,39 weeks,38 weeks,37 weeks and 36 weeks,respectively.Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals.Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents.Large variation of LOS independent of infant characteristics existed,indicating variation of care practices requiring further investigation and quality improvement.