ABSTRACT

Background

Large numbers of preterm infants are born in middle-income countries and neonatal care is improving in these countries. Few studies have compared clinical outcome in preterm infants in a tertiary neonatal unit in a middle-income country with one in a high-income country.

Objective

To compare the short-term outcome in preterm infants of ≤30 weeks gestation admitted to a tertiary neonatal unit in Bengaluru, India and in London, UK.

Methods

This was a retrospective observational study using anonymised data from electronic patient records. Preterm infants born at ≤30 weeks gestation admitted to neonatal units in Bengaluru (n = 294) and London (n = 740) over a 5-year period (January 2011 to December 2015) were compared.

Results

Fewer mothers in the Bengaluru centre received antenatal steroids (37% vs 73%, p < 0.001). The incidence of retinopathy of prematurity requiring treatment (12.9% vs 7.7%, NS), treated patent ductus arteriosus (32.3% vs 10.7%, NS) and blood culture-positive sepsis (32.4% vs 1.7%, p < 0.001) was higher in infants in the Indian centre. Overall survival was 83% vs 87.2% (NS) in the Bengaluru and the London cohorts, respectively. Survival of infants born at ≤28 weeks gestation was lower in Bengaluru than in London [24 weeks: 33.0% vs 79.3% (NS); 25 weeks: 50.0% vs 78.9%, p = 0.02; 26 weeks: 45.2% vs 86.5%, p < 0.01; 27 weeks: 79.3% vs 91.3% (NS); 28 weeks 82.5% vs 94.1%, p = 0.03].

Conclusion

The survival of infants ≤28 weeks gestation was significantly lower in the Bengaluru centre. Increasing the provision of antenatal corticosteroids may improve the outcome in these infants. 

Abbreviations

BPD: bronchopulmonary dysplasia; CPAP: continuous positive airway pressure; EPR: electronic patient records; HIC: high-income countries; HDU: high dependency unit; hsPDA: haemodynamically significant patent ductus arteriosus; IVH: intraventricular haemorrhage; ITU: Intensive Care Unit, IUGR: intrauterine growth restriction; LAMA: leaving against medical advice; LMIC: low- and middle-income countries; NICU: neonatal intensive care unit; NNFI: National Neonatal Forum of India; NS: not significant; NTS: neonatal transfer service; NNAP: National Neonatal Audit Programme; NHM: National Health Mission; NMR: neonatal mortality rate; NEC: necrotising enterocolitis; NS: not significant; PDA: patent ductus arteriosus; ROP: retinopathy of prematurity; SCBU: special care baby unit; VLBW: very low birthweight; WHO: World Health Organization

中文翻译：

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一项研究比较了印度班加罗尔的三级新生儿护理单位和英国伦敦的妊娠 ≤ 30 周早产儿的短期结果

摘要

背景

大量早产儿出生在中等收入国家，这些国家的新生儿护理正在改善。很少有研究比较中等收入国家三级新生儿单位早产儿与高收入国家早产儿的临床结果。

客观的

比较印度班加罗尔和英国伦敦三级新生儿病房收治的妊娠 ≤ 30 周早产儿的短期结果。

方法

这是一项回顾性观察研究，使用来自电子病历的匿名数据。比较了 5 年期间（2011 年 1 月至 2015 年 12 月）在班加罗尔 ( n = 294) 和伦敦 ( n = 740) 的新生儿单元中出生的 ≤ 30 孕周出生的早产儿。

结果

班加罗尔中心接受产前类固醇的母亲较少（37% vs 73%，p < 0.001）。需要治疗的早产儿视网膜病变（12.9% vs 7.7%，NS）、治疗的动脉导管未闭（32.3% vs 10.7%，NS）和血培养阳性脓毒症（32.4% vs 1.7%，p < 0.001）的发生率较高在印度中心的婴儿中。班加罗尔和伦敦队列的总生存率分别为 83%和87.2% (NS)。班加罗尔孕 28 周以下出生婴儿的存活率低于伦敦 [24 周：33.0%对79.3% (NS)；25 周：50.0%对78.9%，p= 0.02; 26 周：45.2%对86.5%，p < 0.01；27 周：79.3%对91.3% (NS)；28 周 82.5%对94.1%，p = 0.03]。

结论

在班加罗尔中心，≤28 周妊娠婴儿的存活率显着降低。增加产前皮质类固醇的供应可能会改善这些婴儿的结局。 

缩写

BPD：支气管肺发育不良；CPAP：持续气道正压通气；EPR：电子病历；HIC：高收入国家；HDU：高依赖单元；hsPDA：具有血流动力学意义的动脉导管未闭；IVH：脑室内出血；ITU：重症监护室，IUGR：宫内生长受限；喇嘛：违背医嘱离开；LMIC：低收入和中等收入国家；NICU：新生儿重症监护室；NNFI：印度全国新生儿论坛；NS：不显着；NTS：新生儿转运服务；NNAP：国家新生儿审计计划；NHM：国家卫生使命；NMR：新生儿死亡率；NEC：坏死性小肠结肠炎；NS：不显着；PDA：动脉导管未闭；ROP：早产儿视网膜病变；SCBU：特殊护理婴儿单元；VLBW：极低出生体重；世界卫生组织：世界卫生组织