The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network

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2024年6月14日

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Tiantian Xiao,
Liyuan Hu,
Huiyao Chen,
Xinyue Gu,
Jianguo Zhou,
Yanping Zhu,
Xiaoping Lei,
Siyuan Jiang,
Yulan Lu,
Xinran Dong,
Lizhong Du,
Shoo K. Lee,
Rong Ju,
Wenhao Zhou,
Lin Yuan,
Tongling Yang,
Hao Yuan,
Li Wang,
Chao Chen,
Yun Cao,
Xiuyong Chen,
Huyan Zhang,
Xiuying Tian,
Jingyun Shi,
Zhankui Li,
Chuanzhong Yang,
Ling Liu,
Zuming Yang,
Jianhua Fu,
Yong Ji,
Dongmei Chen,
Changyi Yang,
Rui Chen,
Xiaoming Peng,
Ruobing Shan,
Shuping Han,
Hui Wu,
Lili Wang,
Qiufen Wei,
Mingxia Li,
Yiheng Dai,
Hong Jiang,
Wenqing Kang,
Xiaohui Gong,
Xiaoyun Zhong,
Yuan Shi,
Shanyu Jiang,
Bing Sun,
Long Li,
Zhenlang Lin,
Jiangqin Liu,
Jiahua Pan,
Hongping Xia,
Xiaoying Li,
Falin Xu,
Yinping Qiu,
Li Ma,
Ling Yang,
Xiaori He,
Yanhong Li,
Deyi Zhuang,
Qin Zhang,
Wenbin Dong,
Jianhua Sun,
Kun Liang,
Huaiyan Wang,
Jinxing Feng,
Liping Chen,
Xinzhu Lin,
Chunming Jiang,
Chuan Nie,
Linkong Zeng,
Mingyan Hei,
Hongdan Zhu,
Hongying Mi,
Zhaoqing Yin,
Hongxia Song,
Hongyun Wang,
Dong Li,
Yan Gao,
Yajuan Wang,
Liying Dai,
Liyan Zhang,
Yangfang Li,
Qianshen Zhang,
Guofang Ding,
Jimei Wang,
Xiaoxia Chen,
Zhen Wang,
Zheng Tang,
Xiaolu Ma,
Xiaomei Zhang,
Xiaolan Zhang,
Fang Wu,
Yanxiang Chen,
Ying Wu

摘要

Background

The occurrence of severe intraventricular hemorrhage (sIVH) was high in the very preterm infants (VPIs) in China. The management strategies significantly contributed to the occurrence of sIVH in VPIs. However, the status of the perinatal strategies associated with sIVH for VPIs was rarely described across the multiple neonatal intensive care units (NICUs) in China. We aim to investigate the characteristics of the perinatal strategies associated with sIVH for VPIs across the multiple NICUs in China.

Methods

This was a retrospective analysis of data from a prospective cohort of Chinese Neonatal Network (CHNN) dataset, enrolling infants born at 24⁺⁰—31⁺⁶ from 2019 to 2021. Eleven perinatal practices performed within the first 3 days of life were investigated including antenatal corticosteroids use, antenatal magnesium sulphate therapy, intubation at birth, placental transfusion, need for advanced resuscitation, initial inhaled gas of 100% FiO2 in delivery room, initial invasive respiratory support, surfactant and caffeine administration, early enteral feeding, and inotropes use. The performances of these practices across the multiple NICUs were investigated using the standard deviations of differences between expected probabilities and observations. The occurrence of sIVH were compared among the NICUs.

Results

A total of 24,226 infants from 55 NICUs with a mean (SD) gestational age of 29.5 (1.76) and mean (SD) birthweight of 1.31(0.32) were included. sIVH was detected in 5.1% of VPIs. The rate of the antenatal corticosteroids, MgSO4 therapy, and caffeine was 80.0%, 56.4%, and 31.5%, respectively. We observed significant relationships between sIVH and intubation at birth (AOR 1.52, 95% CI 1.13 to 1.75) and initial invasive respiratory support (AOR 2.47, 95% CI 2.15 to 2.83). The lower occurrence of sIVH (4.8%) was observed corresponding with the highest utility of standard antenatal care, the lowest utility of invasive practices, and early enteral feeding administration.

Conclusions

The current evidence-based practices were not performed in each VPI as expected among the studied Chinese NICUs. The higher utility of the invasive practices could be related to the occurrence of sIVH.