Hong Kong’s preterm babies have higher survival rate than most countries
A study recently showed that preterm babies in Hong Kong have significantly higher overall survival rates upon discharge from the hospital compared with that of the Vermont Oxford Network (VON), an international neonatal database. However, the rate of bronchopulmonary dysplasia (BPD) and growth failure is significantly higher in the Hong Kong cohort.
Investigators from the Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital (QMH) recently showed that the overall survival rate of preterm babies discharged from QMH was 87 percent, compared with 80 percent for those in VON (p=0.0006). [Hong Kong Med J 2017;23:381-386]
The retrospective study, which included 449 infants born at 23–35 weeks age of gestation with a birth weight range of 345–1890 g from January 2005 to December 2014, however reported that the rate of both BPD (40 vs 34 percent; p=0.011) and growth failure (84 vs 42 percent; p=0.0001) were higher in the QMH vs VON group.
“Managing respiratory distress syndrome [RDS] with continuous positive airway pressure support with subsequent selective surfactant administration to avoid unnecessary or prolonged ventilation could reduce ventilator-associated lung injury and BPD,” the authors pointed out.
The higher BPD rate could be related to higher rates of chorioamnionitis (infection of the placental membranes) in the QMH vs VON group (24.3 vs 17.9 percent; p=0.0006).
“Apart from affecting lung growth and maturation, postnatal growth failure is associated with poor long-term neurocognitive outcome… One possible explanation for the higher growth failure rate in the QMH group is probably the lack of guidelines about preterm infant nutrition,” the authors commented.
“To improve the growth of preterm infants, a standardized nutritional pathway for very-low-birth-weight (VLBW) infants has been in use since 2015 and its effect has yet to be evaluated,” the authors added.
There was no significant difference in the rate of early-onset sepsis between the QMH and VON groups (p=0.792). However, the rate of late-onset sepsis was significantly lower in the QMH vs VON group (10 vs 16 percent; p=0.0002).
No significant differences were found on the overall frequencies of other neonatal complications such as necrotizing enterocolitis (p=0.693), severe retinopathy of prematurity (p=0.100), severe intraventricular haemorrhage (p=0.070), and periventricular leukomalacia (p=0.963) between the QMH and VON groups.
“Mortality and morbidity rates at our centre compare favourably with international standards, but the rates of BPD and growth failure are concerning. A regular benchmarking process is crucial to audit any change in clinical outcomes after implementation of a local quality improvement project,” the authors concluded.
The VON is a neonatal database composed of data collected from 38,754 VLBW infants and infants who fulfill other eligibility requirements from all over the world since 1989. QMH is amongst the 1,000 participating centres in this international network.