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Abstract：
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.
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.
摘要：
背景：在中国，严重脑室内出血（sIVH）的发生率在极早产儿（VPI）中很高。管理策略显著促进了VPI中sIVH的发生。然而,在中国的多个新生儿重症监护病房(NICU)中,很少描述与VPI的sIVH相关的围产期策略的状况.我们旨在调查中国多个NICU中与VPI的sIVH相关的围生期策略的特征。
方法：这是对来自中国新生儿网络（CHNN）数据集的前瞻性队列数据的回顾性分析，从2019年到2021年，招收24+0-31+6岁出生的婴儿。在生命的前3天内进行的11个围产期实践进行了调查，包括产前皮质类固醇的使用，产前硫酸镁治疗，出生时插管,胎盘输血,需要先进的复苏，分娩室中100%FiO2的初始吸入气体，初始有创呼吸支持，表面活性剂和咖啡因给药，早期肠内喂养，和同向异构体使用。使用预期概率和观察值之间的差异的标准偏差研究了这些实践在多个NICU中的表现。比较了NICU中sIVH的发生情况。
结果：共纳入来自55个NICU的24,226名婴儿，平均(SD)胎龄29.5(1.76)，平均(SD)出生体重1.31(0.32)。在5.1%的VPI中检测到sIVH。产前皮质类固醇的发生率，MgSO4治疗，咖啡因占80.0%,56.4%,和31.5%，分别。我们观察到sIVH和出生时插管（AOR1.52，95％CI1.13至1.75）与初始有创呼吸支持（AOR2.47，95％CI2.15至2.83）之间存在显着关系。观察到sIVH的发生率较低（4.8％），与标准产前护理的最高效用相对应。侵入性实践的最低效用，和早期肠内喂养管理。
结论：在所研究的中国NICU中，每个VPI均未按照预期进行当前的循证实践。侵入性实践的较高效用可能与sIVH的发生有关。
方法：这是对来自中国新生儿网络（CHNN）数据集的前瞻性队列数据的回顾性分析，从2019年到2021年，招收24+0-31+6岁出生的婴儿。在生命的前3天内进行的11个围产期实践进行了调查，包括产前皮质类固醇的使用，产前硫酸镁治疗，出生时插管,胎盘输血,需要先进的复苏，分娩室中100%FiO2的初始吸入气体，初始有创呼吸支持，表面活性剂和咖啡因给药，早期肠内喂养，和同向异构体使用。使用预期概率和观察值之间的差异的标准偏差研究了这些实践在多个NICU中的表现。比较了NICU中sIVH的发生情况。
结果：共纳入来自55个NICU的24,226名婴儿，平均(SD)胎龄29.5(1.76)，平均(SD)出生体重1.31(0.32)。在5.1%的VPI中检测到sIVH。产前皮质类固醇的发生率，MgSO4治疗，咖啡因占80.0%,56.4%,和31.5%，分别。我们观察到sIVH和出生时插管（AOR1.52，95％CI1.13至1.75）与初始有创呼吸支持（AOR2.47，95％CI2.15至2.83）之间存在显着关系。观察到sIVH的发生率较低（4.8％），与标准产前护理的最高效用相对应。侵入性实践的最低效用，和早期肠内喂养管理。
结论：在所研究的中国NICU中，每个VPI均未按照预期进行当前的循证实践。侵入性实践的较高效用可能与sIVH的发生有关。
