Mortality, Morbidity, and Care Practices for 1750 Very Low Birth Weight Infants, 2016–2021
Introduction
Very low birth weight (VLBW) infants, defined as those weighing less than 1500 grams at birth, represent a critical population in neonatology. Despite advancements in neonatal intensive care, morbidity and mortality remain significant challenges for this group. This study aimed to analyze the clinical characteristics, care practices, and outcomes of VLBW infants admitted to West China Second Hospital between 2016 and 2021. The findings were compared with data from the previous seven years (2009–2015) to evaluate trends and improvements in neonatal care.
Background
Globally, over 20 million infants are born with low birth weight annually, accounting for 15–20% of live births. The survival rates of VLBW infants vary widely across countries, with Japan reporting the highest survival rate (93%) and Spain the lowest (78%). In China, the survival rate of infants with gestational age below 32 weeks has reached 95.4%, reflecting significant progress in neonatal care. However, disparities in mortality and major morbidities, such as intraventricular hemorrhage (IVH), sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP), persist between China and developed countries. This study provides a comprehensive analysis of the care practices and outcomes of VLBW infants in a major Chinese neonatal center.
Methods
A retrospective cohort study was conducted at West China Second Hospital from January 2016 to December 2021. The study included neonates with a birth weight of less than 1500 grams and excluded those with severe congenital malformations. Data on mortality, care practices, and major morbidities were collected and compared with data from 2009 to 2015. Ethical approval was obtained, and informed consent was waived due to the retrospective nature of the study.
Care Practices
The study analyzed several care practices, including delivery room resuscitation, respiratory management, postnatal corticosteroid use, and parenteral nutrition. Delivery room resuscitation was required for 42.9% of the neonates, with higher rates observed in extremely low birth weight (ELBW) infants and those with gestational age (GA) below 28 weeks. Respiratory management included non-invasive ventilation (53.9%), invasive ventilation (38.2%), and high-frequency ventilation (9.9%). Pulmonary surfactant was administered to 55.1% of neonates, and caffeine was given to 81.4% to prevent or treat apnea. Postnatal corticosteroids were used in 19.2% of cases, primarily in ELBW infants and those with GA below 28 weeks. Parenteral nutrition was provided for a median of 19 days.
Major Morbidities
Among the 1517 neonates who received complete treatment, the most common morbidities were pneumonia (81.8%), neonatal respiratory distress syndrome (NRDS) (60.1%), and BPD (28.7%). Other significant conditions included pulmonary hemorrhage (8.4%), apnea (22.0%), IVH (28.5%), severe IVH or periventricular leukomalacia (PVL) (7.6%), ROP (29.9%), severe ROP (2.0%), NEC (5.7%), and sepsis (11.1%). The incidence of these conditions varied by birth weight and GA, with higher rates observed in ELBW infants and those with lower GA.
Prognosis
The total mortality rate for the cohort was 9.7%, with an in-hospital mortality rate of 3.0%. Mortality rates decreased with increasing birth weight and GA. The top causes of in-hospital deaths were sepsis, NRDS, and NEC. Among neonates discharged against medical advice (DAMA), the leading causes of death were NRDS, sepsis, and severe IVH. The study highlighted the importance of early intervention and comprehensive care in improving outcomes for VLBW infants.
Comparison with 2009–2015
The study compared data from 2016–2021 with the previous seven years (2009–2015). The proportion of ELBW infants and those with GA below 28 weeks increased significantly in the recent period. Care practices, including delivery room resuscitation and the use of non-invasive ventilation, also improved. The incidence of NRDS and BPD increased, while rates of apnea, IVH, and severe IVH/PVL decreased. Total and in-hospital mortality rates were significantly lower in 2016–2021, reflecting advancements in neonatal care.
Discussion
The study underscores the progress made in reducing mortality and improving outcomes for VLBW infants in China. However, the increasing incidence of NRDS and BPD poses ongoing challenges. The findings highlight the importance of early administration of antenatal corticosteroids, improved respiratory management, and comprehensive nutritional support. The study also emphasizes the need for continued research and quality improvement initiatives to address the remaining gaps in neonatal care.
Conclusion
This study provides valuable insights into the care practices and outcomes of VLBW infants in a major Chinese neonatal center. The findings demonstrate significant improvements in mortality rates and reductions in severe neurological morbidities. However, the increasing incidence of NRDS and BPD underscores the need for ongoing efforts to optimize care for this vulnerable population. The study highlights the importance of multidisciplinary collaboration, early intervention, and evidence-based practices in improving the survival and long-term prognosis of VLBW infants.
doi.org/10.1097/CM9.0000000000002923
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