Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008–2017
Authors: Wu Fan , Liu Guosheng , Feng Zhoushan , Tan Xiaohua , Yang Chuanzhong , Ye Xiaotong , Dai Yiheng , Liang Weiyi , Ye Xiuzhen , Mo Jing , Ding Lu , Wu Benqing , Chen Hongxiang , Li Chiwang , Zhang Zhe , Rong Xiao , Shen Wei , Huang Weimin , Yang Bingyan , Lv Junfeng , Huo Leying , Huang Huiwen , Rao Hongping , Yan Wenkang , Yang Yong , Ren Xuejun , Wang Fangfang , Liu Dong , Diao Shiguang , Liu Xiaoyan , Meng Qiong , Wang Yu , Wang Bin , Zhang Lijuan , Huang Yuge , Ao Dang , Li Weizhong , Chen Jieling , Chen Yanling , Li Wei , Chen Zhifeng , Ding Yueqin , Li Xiaoyu , Huang Yuefang , Lin Niyang , Cai Yangfan , Han Shasha , Jin Ya , Wan Zhonghe , Ban Yi , Bai Bo , Li Guanghong , Yan Yuexiu , Cui Qiliang 
Published: November 2019

Abstract

Background
An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province.

Methods
A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008–2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed.

Results
During 2008–2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival.

Conclusions
Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.