Prevalence of major morbidities and outcome of all hospitalized neonates. A retrospective cohort study of Huai'an neonatal survivals

Background Reliable data for causal implication of neonatal survival in China are lacking. We assumed that by analyzing surviving data of in-hospital neonatal care based on all livebirths in Huai'an, prevalence of neonatal morbidity, mortality and causal relations may be derived comprehensively. Materials and methods Data of all regionally hospitalized neonates were retrospectively linked with corresponding whole livebirths (59,056) in 2015 as a cohort. Diagnoses of diseases and causes of deaths were redefined and categorized. Disease patterns, prevalence of morbidities, case-fatality rate (CFR), and cause-specific mortality rate (CSMR) referring to livebirths were presented. Perinatal and disease-specific risks of death were estimated by multivariable logistic regression. Results In 7,960 (134.8 parts per thousand) hospitalized patients, 168 (2.1%) died in hospital (2.85 parts per thousand of livebirths). Prevalence of major morbidities were 76.8 parts per thousand hyperbilirubinemia, 57.4 parts per thousand pneumonia, 32.7 parts per thousand intraventricular hemorrhage, 20.7 parts per thousand sepsis, 20.2 parts per thousand birth asphyxia, 9.69 parts per thousand congenital anomalies (CA), and 5.30 parts per thousand respiratory distress syndrome (RDS). The CFR (CSMR) of major diseases were 30.4% (0.12 parts per thousand) meconium aspiration syndrome, 17.6% (0.22 parts per thousand) necrotizing enterocolitis, 14.1% (0.75 parts per thousand) RDS, 9.09% (0.88 parts per thousand) CA, 5.26% (0.07 parts per thousand) bronchopulmonary dysplasia, 1.71% (0.36 parts per thousand) sepsis and 1.51% (0.31 parts per thousand) asphyxia. Overall mortality rates were 4.6% and 6.8% in the preterm and low birthweight, and >50% in those of <28 week gestation or <1000 g birthweight, respectively. Mortality risks associated with the perinatal and neonatal morbidities were markedly declined with variable magnitude by multivariable regression models. Conclusions The in-hospital neonatal survival datafile, depicted as the prevalence of major morbidities and CSMR of livebirth population in Huai'an, denoted overall and specific quality and efficiency of the perinatal-neonatal care system. Its concept and methodology should be relevant, and outcome extrapolated, to other countries or domestic regions, with similar socioeconomic development.