Early versus delayed extubation in extremely preterm neonates: a retrospective cohort study

Introduction The commonest cause of death in preterm neonates worldwide is respiratory distress syndrome (RDS). In Fiji, prematurity and RDS have been identified as important causes of neonatal mortality and surfactant was added to supportive care in 2015. This retrospective cohort study describes the RDS epidemiology in Fiji’s major neonatal centre prior to surfactant introduction. Methods RDS-related intensive care admissions in 2013 and 2014 were reviewed and clinical information was extracted from medical records. Subsequent readmissions of RDS cases were also retrieved. Results The rate of RDS was 6.7 (95% confidence interval 5.5 – 8.0) per 1,000 live births. There were 36 RDS deaths. No cases who died received more than one dose of corticosteroids, compared to 25.3% of survivors. Conclusion Death from RDS was high, and is consistent with that in other low- and middle-income countries prior to the uptake of surfactant therapy. Improving antenatal corticosteroid use and access to surfactant therapy is likely to improve outcomes.

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Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001149 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001149

Author(s):

Nem Yun Boo ◽

Seok Chiong Chee ◽

Siew Hong Neoh ◽

Eric Boon-Kuang Ang ◽

Ee Lee Ang ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Neonatal Intensive Care ◽

Surfactant Therapy ◽

Preterm Neonates ◽

Very Preterm ◽

Increased Risk ◽

Care Practices

ObjectivesTo determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.DesignRetrospective cohort study.Setting43 Malaysian neonatal intensive care units.Patients29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.Main outcome measuresCare practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).ResultsDuring this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C–35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.ConclusionSurvival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.

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