Supine versus non-supine sleep position in hospital for preventing morbidity and mortality in spontaneously breathing preterm infants

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

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Can prophylactic nasal continuous positive airway pressure help to prevent morbidity and mortality in very preterm infants?

Cochrane Clinical Answers ◽

10.1002/cca.1374 ◽

2016 ◽

Keyword(s):

Continuous Positive Airway Pressure ◽

Preterm Infants ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Morbidity And Mortality ◽

Very Preterm Infants ◽

Very Preterm

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Infant Sleep Position: Pediatricians' Advice to Parents

PEDIATRICS ◽

10.1542/peds.95.1.55 ◽

1995 ◽

Vol 95 (1) ◽

pp. 55-58

Author(s):

Bonnie B. Hudak ◽

Jane O'Donnell ◽

Nadine Mazyrka

Keyword(s):

Primary Care ◽

New York ◽

Primary Care Physicians ◽

Sleep Position ◽

Infant Sleep ◽

Sources Of Information ◽

Professional Literature ◽

Infant Sleep Position ◽

Supine Sleep ◽

Question Survey

Objective. The American Academy of Pediatrics' (AAP) recommendation for side or supine sleep position in healthy babies has generated much controversy. We surveyed primary care physicians to determine the effect of the AAP statement on physician attitude toward infant sleep position and advice to parents. Methods. We sent a 23-question survey to 194 physicians in Western New York. The survey addressed their attitude toward the AAP recommendations and its impact on their advice to parents. Results. Of the 149 physicians treating newborns, 121 (82%) completed the questionnaire; 98% were aware of the AAP statement. The most common sources of information were the AAP (86%) and professional literature (77%). Of the respondents, 79% agreed with the AAP statement. Reasons for reservation were lack of data (64%), potential adverse consequences of supine position (52%), and their own experience (47%). Gender, years in practice, and type of reimbursement did not influence attitude toward the AAP recommendation. The AAP statement increased the frequency with which physicians routinely discussed sleep position from 34 to 70% (P < .02). Physicians recommending the prone position decreased from 57 to 7% (P < .001), while those recommending supine sleep position increased from 10 to 42% (P < .001). Conclusions. Most physicians agreed with the AAP statement and more frequently discussed sleep position following the AAP recommendations. However, they did not routinely recommend supine sleep position. The majority (69%) recommended the side position even though it is unstable. Although the AAP statement has increased discussion of infant sleep position by primary care physicians in WNY, only a minority recommend that infants sleep supine.

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Vaccinations in Infants Born Preterm: An Update

Current Pediatric Reviews ◽

10.2174/157339631666620011609445 ◽

2020 ◽

Vol 16 (2) ◽

pp. 148-155

Author(s):

Areti Aphrodite Sioriki ◽

Despoina Gkentzi ◽

Evangelia Papadimitriou ◽

Gabriel Dimitriou ◽

Ageliki Karatza

Keyword(s):

Preterm Infants ◽

Vaccine Safety ◽

Full Term ◽

Morbidity And Mortality ◽

Term Infants ◽

Safety And Efficacy ◽

Vaccine Preventable Diseases ◽

Increased Risk ◽

Protective Antibodies

Infants born prematurely (before completion of 37 weeks of gestation) are at increased risk of morbidity and mortality due to vaccine preventable diseases, mostly because of their immunological immaturity and failure of transfer of maternal protective antibodies. Despite their great need of being vaccinated, concerns on vaccine safety and efficacy, constitute the main reasons for which vaccinations are often delayed in this group. In this review we summarize the latest evidence on vaccine safety, efficacy and immunogenicity in preterm infants which is similar to full-term infants. Therefore there is no reason for delaying vaccination in this population.

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