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Am J Perinatol 2021; 38(10): 1048-1056
DOI: 10.1055/s-0040-1701611
Original Article

The Etiology of Neonatal Intensive Care Unit Death in Extremely Low Birth Weight Infants: A Multicenter Survey in China

Jianguo Zhou
1   Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Yin Ba
1   Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Yang Du
1   Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Sam Bill Lin
1   Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
Chao Chen
1   Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China
,
on behalf of the Chinese Collaborative Study Group for Etiologies of NICU Deaths› Author Affiliations
Funding This study was supported by grants from NSFC (grant number: 81801502).
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Abstract

Objective The aim of this study is to identify causes of neonatal intensive care unit (NICU) death in extremely low birth weight (ELBW) infants less than 1,000 g admitted in Chinese tertiary NICUs.

Study design We retrospectively collected data on 607 ELBW infants from 39 level III NICUs from July 2016 to June 2019. The primary causes of death were compared among different gestation age, postnatal age groups, and areas with variable economic status.

Results Among all 607 ELBW NICU deaths, 47.1% were multiple gestation with high rate of in vitro fertilization (IVF) (43.3%); 53.4 and 34.1% received any or full course of antenatal corticosteroid (ACS). The most common causes of ELBW NICU death were respiratory distress syndrome-related neonatal respiratory failure (RDS-NRF, 43.5%), severe infection (19.1%), necrotizing enterocolitis or bowel perforation (9.4%), severe central nervous system injury (8.4%), and bronchopulmonary dysplasia-related respiratory failure (BPD-NRF, 7.7%). Causes of ELBW NICU death varied across postnatal age groups. RDS-NRF was the leading cause of early neonatal death, while severe infection in late neonatal death and BPD in postneonatal EBLW NICU death. RDS-NRF, severe brain injury, and asphyxia were most likely to die at early neonatal age (median age [interquartile range], 2 [0–5], 6 [3–9], and 3 [1–6] days, respectively) while severe infection and necrotizing enterocolitis (NEC) at late neonatal age, BPD-NRF at postneonatal age.

Conclusion In Chinese tertiary NICUs, the major causes of death in extremely low birth weight infants were RDS, infection, NEC, brain injury and BPD, and they varied with postnatal age. Developing specific prevention strategies for identified causes of death in ELBW NICU may potentially improve ELBW survival.

Keywords

neonatal intensive care unit death - extremely low birth weight infants - respiratory distress syndrome - necrotizing enterocolitis - bronchopulmonary dysplasia

Authors' Contribution

J.Z. carried out conceptualization, planning, data collection, first draft, and revision of manuscript. Y.B. performed planning, data and collection. Y.D. dedicated to data analysis and revision of manuscript. S.B.L. contributed in revision of manuscript. C.C. helped in conceptualization, planning, supervision, and revision of manuscript. All the authors consented to the final manuscript as submitted.


Chinese Collaborative Study Group

The following institutions (city and province, municipality, or autonomous regions) and investigators participated in the Chinese Collaborative Study Group for etiologies of NICU deaths. Children's Hospital of Fudan University, Shanghai (C.C.[Study director], J.Z. [coordinator], Y.B.); Guangdong Maternal and Children's Hospital, Guangzhou, Guangdong (Jie Yang and Junping Wang); Gansu Provincial Maternity and Child-care Hospital Lanzhou, Gansu (Jingyun Shi, Qiangyong Sun, and Yuru Zhu); Ningbo Women and Children's Hospital, Ningbo, Zhejiang (Qin Lv and Guangguo Men); Quanzhou Children's Hospital, Quanzhou, Fujian (Dongmei Chen, Ruiquan Wang and Lingyu Fang); Guangxi Maternity Hospital, Nanning, Guangxi (Qiufen Wei, Xiaofang Guo, and Lin Feng); Qilu Children's Hospital of Shandong University, Jinan, Shandong (Xiaoying Li and Xianghong Liu); Children's Hospital of Shanghai, Shanghai (Gang Qiu and Wenchao Hong); Shaoxing maternity Hospital, Shaoxing, Zhejiang (Hongdan Zhu and Jing Pan); The affiliated Hospital of southwest medical University, Luzhou, Sichuan (Wenbin Dong and Xingling Liu); Henan Children's Hospital, Zhengzhou, Henan (Wenqing Kang and Xiaoyuan Zhang); Hunan Children's Hospital, Changsha, Hunan (Xirong Gao and Yan Zhuang); Changzhi Maternity Hospital, Changzhi, Shanxi (Xiufang Feng, Xia Chang, and Maomao Yue); The First Hospital of Jilin University, Changchun, Jilin (Hui Wu, Qing Li, and Jun Han); The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang (Mingxia Li, Yanping Zhu, and Le Wang); Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang (Shangqin Chen and Si Chen); Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian (Xinzhu Lin, Simin Ma, and Linlin Wu); Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi (Liping Chen and Limin Zhou); Shenzhen Maternity and Child Healthcare Hospital Southern Medical University, Shenzhen, Guangdong (Chuanzhong Yang and Panpan Sun); Chengdu Women's and Children's central Hospital, Chengdu, Sichuan (Rong Ju, Qisi Zhao, and Ling Zhu); Anhui Provincial Children's Hospital, Hefei, Anhui (Hong Zheng and Lili Wang); Baoji Maternal and Children's Hospital, Baoji, Shaanxi (Heqin Li and Shuli Hu); Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu (Rui Cheng and Yue Wu); The Northwest Women and Children's Hospital, Xi'an, Shaanxi (Zhankui Li, Jinzhen Guo, and Juan Zhang); Guiyang Maternity and Child Health Care Hospital, Guiyang, Guizhou (Ling Liu, Yongjun Shi, and Yikang Fu); Kunming Children's Hospital, Kunming, Yunnan (Ling liu, Kun Du, and Yangfang Li); Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei (Lingkong Zeng and Luxia Mo); The first people's Hospital of Yinchuan, Yinchuan, Ningxia (Yanxiang Chen and Nan Fang); Tianjin Children's Hospital, Tianjin (Fang Zhang, Chen Zhang, and Lihong Hao); People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang (Long Li, Nuerya Rejiafu, and Libang Qiao); Hainan Women and Children medical center, Haikou, Hainan (Ling Yang and Wenlin Li); The first affiliated Hospital of Zhengzhou University, Zhengzhou, Henan (Xiuyong Cheng and Qingfei Hao); Beijing Children's Hospital, Capital Medical University, Beijing (Mingyan Hei, Wenjing Geng, and Chanjuan Kuang); Inner Mongolia Maternity Hospital, Hohhot, Inner Mongolia (Hongyun Wang and Wuyun Zhao); The second Hospital of Hebei medical University, Shijiazhuang, Hebei (Wenxiang Guo and Liang Lu); The first affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang (Chunming Jiang and Huiying Liu); Qinghai Women and Children's Healthcare Centre, Xining, Qinghai (Chongde Liu and Zhen Wang); Tibet Autonomous Region People's Hospital, Lasa, Tibet (Hong Wu and Bi Ze); Shengjing Hospital of china medical University, Shenyang, Liaoning (Jian Mao and Meng Wang).




Publication History

Received: 04 November 2019

Accepted: 06 January 2020

Article published online:
26 February 2020

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