Chief Physician Children's Hospital of Chongqing Medical University Chongqing, Chongqing, China (People's Republic)
Background: Significant efforts have been made in China to improve the care of preterm infants with neonatal respiratory distress syndrome (RDS). However, practice variation exists due to disparity in the level of neonatal intensive care and hence outcomes may vary. Objective: To understand current practice in RDS care, investigate variation and explore potential areas for improvement. Design/Methods: We conducted a nationwide, cross-sectional survey involving neonatologists and pediatricians across China. The questionnaire covered various aspects of RDS management. Only one doctor from each hospital could participate. Data were analyzed based on five dimensions: level of the hospital, type of the hospital, city tiers, geographical regions, and doctor’s titles. Results: Questionnaires were collected from 394 hospitals distributed among 30 provincial administrative areas. The hospitals had a median number of 30 beds in the neonatology department. The median numbers of doctor per bed and nurse per bed were 0.27 and 0.72, respectively. (Table 1). 90.0% of preterm infants born at < 34 weeks’ gestation were given antenatal steroids (any dose). Of the 378 delivery hospitals, 310 (82.0%) had oxygen blending capacities in the delivery room (DR), initial fraction of inspired oxygen (FiO2) set showing in Table 1. Tertiary hospitals and pediatric specialty hospitals had higher accessibility to T-piece resuscitators, lung ultrasound and certified milk banks (Table 1). Primarily due to issues of medication delivery and reimbursement, 48.4% of hospitals could not give surfactant in the DR. Non-invasive ventilation (NIV) was initiated in 80.0% of RDS patients with continuous positive airway pressure (CPAP) being the most frequently used initial and post-extubation support modality. 60.4% of doctors used FiO2 as indicator (41.6% of them chose >0.30) for surfactant use in patients under NIV. Most physicians (91.7%) used high frequency oscillatory ventilation as rescue therapy when conventional ventilation (CMV) had failed. However, only 36.9% doctors would use it in extremely preterm infants for primary CMV. As shown in Figure 1, there were significant variations in both resources and care practices among different geographic areas.
Conclusion(s): Across China, significant variations in the care of preterm infants with RDS exist. Improvements in early postnatal respiratory care, such as proper initial FiO2, increasing lower limit of saturation targets, more use of oxygen blenders and T-piece resuscitators are needed. Adjustments in human resources and medical insurance reimbursement might be helpful in improving RDS care in China.
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