Respiratory distress syndrome in inborn preterm neonatesA prospective study from 13 hospitals in China
Multicenter collaborative team for the study of RDS in preterm neonates in urban of China
XU Feng-dan*1,2, DUAN Shun-yan *2, KONG Xiang-yong*2, FENG Zhi-chun*2, ZHANG Shan2, WU Hong-yan2, Lü Hong-yan*3, YANG Li-hong3, WU su-jing3, JU rong*4, WANG jin4, PENG Li4, LI Zhan-kui*5, ZHAO Xiao-lin5, ZENG Shu-juan*6, QIU Hui-xian6, WEN Wei-xi6, WU Hui*7, LI Ying7, LI Lan7, JIA Wen-zheng*8, ZHANG Xue-feng8, GUO Guo8, LIU Wei-peng*9, WANG Feng9, LI Gai-mei9, LIU Fang*10, LI Wei10, ZHAO Xiao-ying10, CHENG Hong-bin*11, XU Yun-bo11, CHEN Wen-chao11, YIN Huan11, DING Yan-jie*12,WANG Xiao-liang12, SHAN Rui-yan12, CHEN Tie-qiang*13, XU Ping*14, HAN Mei-ying14, YANG Chun-yan14(1.Department of Pediatrics, GuangDong Medical University, Dongguan 523808,China; 2.Department of Pediatrics, BaYi Children’S Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital of Southern Medical University, Beijing, 100700,China; 3.Department of Pediatrics,Handan maternity and child care centers, Handan, 056001, China; 4.Neonatal Intensive Care Unit, Chengdu Women & Children’s Central Hospital, Chengdu, 610091, China; 5.Neonatal Intensive Care Unit,Shanxi Maternal and Child Care Service Centre, Xi’an, 710003 ,China; 6.Neonatal Intensive Care Unit, Longgang District Central Hospital of Shenzhen, Shenzhen, 518116, China; 7.Department of Pediatrics, First Hospital of Jilin University, Changchun, 130021, China; 8.Department of Pediatrics, 302 Military Hospital of China, Beijing, 100039, China; 9.Department of Pediatrics, Navy General Hospital, Beijing, 100048,China; 10.Department of Pediatrics, Bethene International Peace Hospital, Shijiazhuang, 050082,China; 11.Department of Neonatology, Huangshi Maternal and Child Health Hospital, Huangshi, 435000, China; 12.Department of Pediatrics,Yantai Yuhuangding Hospital, Yantai, 264000, China; 13.Department of Pediatrics, Changsha Hospital for Maternal and Child Health Care, Changsha, 410007, China;14.Department of Pediatrics, Liaocheng People’s Hospital,Liaocheng, 252000, China)
Abstract: Objective To investigate the morbidity, mortality, characteristics of the complications, high risk factors and the effects of antenatal corticosteroids on the morbidity and prognosis of respiratory distress syndrome in inborn preterm neonates in China. Method Data were collected from January 1, 2014 to December 31, 2014 for premature with gestational age <37 weeks born in Obstetric. The morbidity, mortality, characteristics of the complications, high risk factors, effect of antenatal corticosteroids were analysis retrospectively. Results From a total of 75 360 live birth newborns, there were 7 684 cases (10.2%) of preterm neonates, of which 957 cases (12.5%) were extreme prematurity and 92 cases(1.2%) were severe/moderate prematurity. Of these preterm neonates, a total of 1 177 were classified as RDS(15.3%). The morbidity of RDS in neonates with 24≤GA<25、25≤GA<26、26≤GA<27、27≤GA<28、28≤GA<29、29≤GA<30、30≤GA<31、31≤GA<32、32≤GA<33、33≤GA<34、34≤GA<35、35≤GA<36 and 36≤GA<37 weeks were 100.0%、90.0%、85.0%、85.1%、81.0%、74.3%、55.4%、47.1%、33.1%、17.9%、9.6%、5.0% and 1.9%, respectively. The morbidity of RDS in preterm neonates with BW<500,500-749, 750-999, 1 000-1 499, 1 500-2 499, 2 500-4 000 and more than 4 000 grams were 100.0%,100.0%,79.2%, 55.8%, 15.0%, 3.6% and 9.5%, respectively. The mortality of preterm neonates with RDS was 10.5%. The mortality of RDS in neonates with 24≤GA<25、25≤GA<26、26≤GA<27、27≤GA<28、28≤GA<29、29≤GA<30、30≤GA<31、31≤GA<32、32≤GA<33、33≤GA<34、34≤GA<35、35≤GA<36 and 36≤GA<37 weeks were 100.0%,70.0%, 23.5%, 20.0%, 16.2%, 10.3%, 8.1%, 9.6%, 8.9%, 6.0%, 5.5%, 8.8% and 4.5%, respectively. The incidence of ICH, ROP, BPD, NEC, PDA, pulmonary hemorrhage and sepsis in preterm neonates with RDS were higher than those without RDS. Logistic regressions showed that male, GA<33 weeks, BW<2 500 grams, body length <40 cm, neonatal asphyxia production time≥2 times , and placenta praevia were risk factors for RDS. Multiple pregnancy was protection factor for RDS. In preterm neonates with GA<33 weeks, male, GA<28 weeks, BW<2 500 grams, body length <40 cm, neonatal asphyxia and placenta praevia were risk factors for RDS. Prenatal dexamethasone was protection factor for RDS. In preterm neonates with GA≥33 weeks, male, GA<35 weeks, BW<2 500 grams, neonatal asphyxia, production time ≥2 times, cesarean delivery, placenta previawere risk factors for RDS. Multiple pregnancy was protection factor for RDS. 2 879 cases under went antenatal dexamethasone therapy, corresponding to 37.5%. There was a lower incidence of RDS in neonates with GA<33 weeks in antenatal corticosteroids group compared with non-antenatal corticosteroids group. For neonates with GA<33 weeks, the incidence of RDS and severe RDS, the mortalitywere lower in antenatal corticosteroids group compared with non-antenatal corticosteroids group. The proportion of patients received ≥2 doses of surfactant,the proportion of patients received mechanical ventilation and the median length of mechanical ventilation were lower in antenatal corticosteroids group compared with non-antenatal corticosteroids group,but the differences were not statistically significant. The mean duration of oxygen supplement were longer in antenatal corticosteroids group compared with non-antenatal corticosteroids group, but the differences were not statistically significan. The median length of stay in NICU were longer in antenatal corticosteroids group compared with non-antenatal corticosteroids group.For preterm neonates with GA≥33 weeks with RDS, the incidence of RDS and severe RDS, the proportion of patients received mechanical ventilation, the mean duration of oxygen supplement andthe median length of stay in NICU were higher in antenatal corticosteroids group compared with non-antenatal corticosteroids group. But the other differences between these two groups was not statistically significant. Conclusions The incidence of preterm neonates in China increased. The survival rate in preterm neonates, extreme prematurity and severe/moderate prematurity improved obviously than ever before. The mortality and morbidity of complications of preterm neonates with RDS was higher than those without RDS. Most of the high risk factors of RDS in preterm neonates with GA<33 weeks were related to their immature lung development. Prenatal dexamethasone can effectively reduce the incidence of RDS and improve the prognosis. For preterm neonates with GA≥33 weeks, the high risk factors of RDS tended to be related to perinatal factors, the protective effect of dexamethasone was not obviously
中国城市多中心早产儿呼吸窘迫综合征调查协作组. 中国13家医院住院分娩早产儿呼吸窘迫综合征前瞻性调查分析[J]. 发育医学电子杂志, 2016, 4(2): 106-119.
Multicenter collaborative team for the study of RDS in preterm neonates in urban of China. Respiratory distress syndrome in inborn preterm neonatesA prospective study from 13 hospitals in China. Journal of Developmental Medicine(Electronic Version), 2016, 4(2): 106-119.
2016, Vol. 4 
