title: Mortality of neonatal respiratory failure from Chinese northwest NICU network.
abstract: OBJECTIVE
  We aimed to evaluate the efficacy of respiratory support and surfactant in incidence, management and outcome of neonatal hypoxemic respiratory failure (NRF) in Chinese emerging regional neonatal-perinatal care system in the era of universal health insurance policy.
  
  
  METHODS
  Clinical data of NRF were prospectively collected in 12 consecutive months from 2011 to 2012 in 12 neonatal intensive care units (NICU) in major cities of Northwest China. NRF was defined as hypoxemia requiring nasal continuous positive airway pressure (nCPAP) or intratracheal ventilation combined with surfactant for at least 24 h, with associated risk factors, mortality rate and major co-morbidities analyzed.
  
  
  RESULTS
  Among 9816 admissions, there were 1324 NRF cases with 60.2% being preterm. The incidence of NRF was 13.4% with a mortality of 15.5%. The major underlying diseases were respiratory distress syndrome (RDS, 38.9%) and pneumonia/sepsis (38.0%). Only 15.9% of NRF and 33.8% of RDS received surfactant, which contributed to >70% and >85% survival in RDS patients of birth weight (BW) < 1500 g and >1500 g, respectively. Multivariate logistic regression analysis showed that premature rupture of membrane ≥ 24 h, very low BW and gestational age < 32 weeks, resuscitation at delivery, illness severity at admission, intratracheal ventilation and sepsis were the independent risk factors for the mortality of NRF. The length and cost of NICU stay for survivors reflected care burden in the era of universal health insurance.
  
  
  CONCLUSIONS
  Surfactant significantly improved the survival of neonates with NRF and RDS, reflecting the respiratory care standard in emerging regional neonatal-perinatal care network with limited resources.
authors.affiliation: a Departments of Pediatrics and Neonatology , Children's Hospital of Fudan University , Shanghai , PR China.|b Laboratory of Neonatal Medicine, National Commission of Health and Family Planning , Shanghai , PR China.|c Department of Neonatology , Northwest Women and Children Hospital/Maternity Hospital of Shaanxi Province , Xi'an , Shaanxi , PR China.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: d Department of Neonatology , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: e Department of Neonatology , Women and Children's Hospital of Gansu Province , Lanzhou , Gansu , PR China.
authors.forename: B
authors.initials: B
authors.lastname: Yi
authors.affiliation: c Department of Neonatology , Northwest Women and Children Hospital/Maternity Hospital of Shaanxi Province , Xi'an , Shaanxi , PR China.
authors.forename: L
authors.initials: L
authors.lastname: Ni
authors.affiliation: f Department of Neonatology , Women and Children's Hospital of Qinghai Province , Xining , Qinghai , PR China.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: g Department of Neonatology , Kashi First Hospital of Xinjiang Uygur Autonomous Region , Kashi , Xinjiang , PR China.
authors.forename: Pulati
authors.initials: P
authors.lastname: Taxi
authors.affiliation: h Department of Neonatology , Maternal and Children Healthcare Hospital of Baoji City , Baoji , Shaanxi , PR China.
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.affiliation: i Department of Neonatology , People's Hospital of Shaanxi Province , Xi'an , Shaanxi , PR China.
authors.forename: Q
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: j Department of Neonatology , Xi'an Municipal Children's Hospital , Xi'an , Shaanxi , PR China.
authors.forename: W
authors.initials: W
authors.lastname: Wang
authors.affiliation: k Department of Neonatology , Women and Children's Hospital of Shanxi Province , Taiyuan , Shanxi , PR China.
authors.forename: Z
authors.initials: Z
authors.lastname: Liu
authors.affiliation: l Department of Neonatology , People's Hospital of Xinjiang Uygur Autonomous Region , Urumqi , Xinjiang , PR China.
authors.forename: L
authors.initials: L
authors.lastname: Li
authors.affiliation: m Department of Neonatology , Women and Children's Hospital of Yinchuan Municipality , Ningxia , PR China , and.
authors.forename: L
authors.initials: L
authors.lastname: Zhao
authors.affiliation: n Department of Neonatology , Women and Children's Hospital of Inner Mongolia Autonomous Region , Hohhot, Inner Mongolia , PR China.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: a Departments of Pediatrics and Neonatology , Children's Hospital of Fudan University , Shanghai , PR China.|b Laboratory of Neonatal Medicine, National Commission of Health and Family Planning , Shanghai , PR China.
authors.forename: B
authors.initials: B
authors.lastname: Sun
mesh_terms: D002681:China; D015897:Comorbidity; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D000071074:Neonatal Sepsis / Q000401:mortality; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D012151:Resuscitation; D012307:Risk Factors
chemical_list: D011663:Pulmonary Surfactants
keywords: Epidemiology; mortality; neonate; prematurity; respiratory distress syndrome; respiratory failure; respiratory therapy; surfactant