Journal Mobile Options
Table of Contents
Vol. 100, No. 1, 2011
Issue release date: June 2011

Mortality of Neonatal Respiratory Failure Related to Socioeconomic Factors in Hebei Province of China

Ma L. · Liu C. · Wang Y. · Li S. · Zhai S. · Gu X. · Liu F. · Yan A. · Guo W. · Li Y. · Xiao M. · Yin J. · Li Y. · Liu X. · Wang R. · Kirpalani H. · Sun B. · Hebei Neonatal Network Study Group
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Dramatic progress has occurred in neonatal intensive care in tertiary centers in mid-eastern China. We investigated the characteristics of neonatal respiratory failure (NRF) including the incidence, management, outcomes and costs in 14 neonatal intensive care units (NICUs) of Hebei, a province at an intermediate economic level in China. Over a period of 12 consecutive months in 2007–2008, perinatal data were collected prospectively from all NICU admissions (n = 11,100). NRF was defined as severe hypoxemia requiring respiratory support for more than 24 h, and was diagnosed in 1,875 newborns (16.9%). The average birth weight of newborns with NRF was 2,200 g (range 600–5,500 g), with 60.9% <2,500 g, and 2% <1,000 g. The male:female ratio was 2.6:1. The leading diagnosis was respiratory distress syndrome; 58.3% of newborns with respiratory distress syndrome received surfactant. Continuous positive airway pressure was used more than ventilation (73.3 vs. 49.1%,p < 0.001). Overall, the mortality rate until discharge was 31.4% (583/1,859). Most deaths (432, 74.1%) followed a parental decision to withdraw care. NRF mortality varied in association with different gross domestic product levels, family annual income and nurse-to-bed ratios. The median cost of a hospital stay was 10,169 CNY (interquartile range: 6,745–16,386) for NRF survivors. We conclude that, despite the available respiratory support in these emerging NICUs, the mortality of NRF remains. This was associated with prematurity, standard of care but also with socioeconomic factors affecting treatment decisions. Assessment of efficacy of respiratory support for NRF in such emerging neonatal services should account for both standard of care and socioeconomic conditions.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Godhagen J, Remo R, Bryant T, Wludyka P, Dailey A, Wood D, et al: The health status of southern children: a neglected regional disparity. Pediatrics 2005;116:e746–e753.
  2. Qian L, Liu C, Zhuang W, Guo Y, Yu J, Chen H, et al and Chinese Collaborative Study Group for Neonatal Respiratory Diseases: Neonatal respiratory failure: a 12-month clinical epidemiologic study from 2004 to 2005 in China. Pediatrics 2008;121:e1115–e1124.
  3. National Bureau of Statistics of China: Chinese statistic yearbook 2008. Available at. http://www.stats.gov.cn/tjgb/ (in Chinese).
  4. Health Department of Hebei Province: The new rural cooperative medical care in central and western regions management capacity-building project management in 2009. Available at http://www.hebwst.gov.cn (In Chinese).
  5. Stark AR: American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics 2004;114:1341–1347.
  6. Raju TN, Higgins RD, Stark AR, Leveno KJ: Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 2006;118:1207–1214.
  7. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM: Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988;82:527–532.
  8. Tingay DG, Mills JF, Morley CJ, Pellicano A, Dargaville PA: Australian and New Zealand Neonatal Network. Trends in use and outcomes of newborn infants treated with high frequency ventilation in Australia and New Zealand, 1996–2003. J Paediatr Child Health 2007;43:160–166.
  9. Horbar JD, Carpenter JH, Buzas J, Soll RF, Suresh G, Bracken MB, et al: Vermont Oxford Network. Timing of initial surfactant treatment for infants 23 to 29 weeks’ gestation: is routine practice evidence based? Pediatrics 2004;113:1593–1602.
  10. Yost CC, Soll RF: Early versus delayed selected surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2000;(2): CD001456.
  11. Soll RF, Morley CJ: Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2001;(2): CD000510.
  12. Halliday HL: Recent clinical trials of surfactant treatment for neonates. Biol Neonate 2006;89:323–329.
  13. Hebei Provincial Bureau of Statistics: Hebei statistic yearbook 2008. Available at (http://www.hetj.gov.cn/) (in Chinese).
  14. Singh J, Fanaroff J, Andrews B, Caldarelli L, Lagatta J, Plesha-Troyke S, et al: Resuscitation in the ‘gray zone’ of viability: determining physician preferences and predicting infant outcomes. Pediatrics 2007;120:519–526.
  15. Miljeteig I, Sayeed SA, Jesani A, Johansson KA, Norheim OF: Impact of ethics and economics on end-of-life decisions in an Indian neonatal unit. Pediatrics 2009;124:e322-e328.
  16. Profit J, Petersen LA, McCormick MC, Escobar GJ, Coleman-Phox K, Zheng Z, et al: Patient-to-nurse ratios and outcomes of moderately preterm infants. Pediatrics 2010;125:320–326.
  17. Tucker J, UK Neonatal Staffing Study Group: Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation. Lancet 2002;359:99–107.
  18. Arad I, Gofin R, Baras M, Bar-Oz B, Peleg O, Epstein L: Neonatal outcome of inborn and transported very-low-birth-weight infants: relevance of perinatal factors. Eur J Obstet Gynecol Reprod Biol 1999;83:151–157.
  19. Walsh-Sukys MC, Fanaroff AA: Perinatal services and resources; in Franaroff AA, Martin RI (eds): Neonatal Perinatal Medicine. St Louis, Mosby, 1997, pp 13–22.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50