Incidence of brain injuries in premature infants with gestational age ≤34 weeks in ten urban hospitals in China 

Hui-Jin Chen, Ke-Lun Wei, Cong-Le Zhou, Yu-Jia Yao, Yu-Jia Yang, Xiu-Fang Fan, Xi-Rong Gao, Xiao-Hong Liu, Ji-Hong Qian, Ben-Qing Wu, Gao-Qiang Wu, Qing-Mei Zhang, Xiao-Lan Zhang

Shanghai, China

Author Affiliations: Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China (Chen HJ); The Second Affiliated Hospital of China Medical University, Shenyang 110004, Liaoning Province, China (Wei KL); Peking University First Hospital, Beijing 100034, China (Zhou CL); West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China (Yao YJ); Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China (Yang YJ); Jinan Women & Children Hospital, Jinan 250012, Shandong Province, China (Fan XF); Hunan Children's Hospital, Changsha 410007, Hunan Province, China (Gao XR); Shenzhen Children's Hospital, Shenzhen 518026, Guangdong Province, China (Liu XH); Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China (Qian JH); Shenzhen City People's Hospital, the Second Affiliated Hospital of Jinan University Medical College, Shenzhen 518020, Guangdong Province, China (Wu BQ); Ulumuqi Women & Children Hospital, Ulumuqi 830000, Xinjiang Uyghur Autonomous Region, China (Wu GQ); Shenyang Women Hospital, Shenyang 110014, Liaoning Province, China (Zhang QM); Shenzhen Maternity and Child Healthcare Hospital, Shenzhen 518028, Guangdong Province, China (Zhang XL)

Corresponding Author: Hui-Jin Chen, MD, Professor of Pediatrics, Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China (Tel: +86-21-65790000-6471; Fax: +86-21-65791316; Email: hjchenk@163.com)

doi: 10.1007/s12519-012-0395-8

Background: There is a large number (1.5 million per year) of premature births in China. It is necessary to obtain the authentic incidences of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), the common brain injuries, in Chinese premature infants. The present multicenter study aimed to investigate the incidence of brain injuries in premature infants in ten urban hospitals in China.

Methods: The research proposal was designed by the Subspecialty Group of Neonatology of Pediatric Society of the Chinese Medical Association. Ten large-scale urban hospitals voluntarily joined the multicenter investigation. All premature infants with a gestational age ≤34 weeks in the ten hospitals were subjected to routine cranial ultrasound within three days after birth, and then to repeated ultrasound every 3-7 days till their discharge from the hospital from January 2005 to August 2006. A uniform data collection sheet was designed to record cases of brain injuries.

Results: The incidences of overall IVH and severe IVH were 19.7% (305/1551) and 4.6% (72/1551), respectively with 18.4% (56/305) for grade 1, 58.0% (177/305) for grade 2, 17.7% (54/305) for grade 3 and 5.9% (18/305) for grade 4 in nine hospitals. The incidences of overall PVL and cystic PVL were 5.0% (89/1792) and 0.8% (14/1792) respectively, with 84.3% (75/89) for grade 1, 13.5% (12/89) for grade 2, and 2.2% (2/89) for grade 3 in the ten hospitals. The statistically significant risk factors that might aggravate the severity of IVH were vaginal delivery (OR=1.883, 95% CI: 1.099-3.228, P=0.020) and mechanical ventilation (OR=4.150, 95% CI: 2.384-7.223, P=0.000). The risk factors that might result in the development of cystic PVL was vaginal delivery (OR=21.094, 95% CI: 2.650-167.895, P=0.000).

Conclusions: The investigative report can basically reflect the incidence of brain injuries in premature infants in major big cities of China. Since more than 60% of the Chinese population live in the rural areas of China, it is expected to undertake a further multicenter investigation covering the rural areas in the future.

Key words: incidence; intraventricular hemorrhage; multicenter investigation; periventricular leukomalacia; premature infants

World J Pediatr 2013;9(1):17-24