To investigate the status of admission and treatment of neonatal respiratory distress
syndrome (RDS) in northwest regions in China.Twenty hospitals (6 secondary hospitals, 2 tertiary grade B hospitals and 12 tertiary
grade A hospitals) from 3 regions participated in the retrospective investigation.
Data of infants with RDS and age ≤3 days admitted to neonatal intensive care units
(NICUs) of participated hospitals from January 1, 2011 to December 31, 2011 were collected
by using descriptive epidemiologic survey methodology. The investigation included
the basic information of children, perinatal risk factors, clinical manifestations
and treatment, complications and prognosis.Of the 17 406 infants admitted to the 20 hospitals under investigation, 580 neonates (3.3%) suffered from RDS and 379 (65.3%) of them were males. Their average gestational age (GA) was (33.0±2.9) weeks and birth weight (BW) was (1 956±647)g. The average age of their mothers was (28±5) years, 19 (3.3%) infants with RDS were conceived with assisted reproductive technologies (ART). The selective cesarean section rate of mothers with gestational age ≥ 37 weeks was 59.3 % (51/86). The median duration and cost of the hospitalization were 13 (6.0, 21.0) days and 14 200 (6 800, 23 200) yuan. The common perinatal risk factors in the order of occurrence rate were 33.1% (192/580) cases of birth asphyxia, 19.7% (114 /580) cases of multiple births, 17.8% (103/580) cases of gestational hypertension, 15.2% (88/580) cases of fetal distress, 13.3% (77/580) cases of premature rupture, 5.7% (33/580) cases of placental abruption, 1.6% (9/580) cases of gestational diabetes, 1.4% (8/580) cases of intrahepatic cholestasis in pregnancy; 23.6% (33/140) cases in Gansu were treated with antenatal steroids, 12.1% (8/66) cases in Xinjiang and 9.4% (25/265) cases in Shaanxi. Shaanxi had the highest rate of applying pulmonary surfactant (PS) and intubate-surfactant-extubate to CPAP (INSURE), 61.6% (226/367) and 57.3% (142/248) respectively, but they had the lowest dosage of PS (80±43) mg/kg. Hospitals in Shaanxi used CPAP as the major assisted ventilation mode (87.5%, 294/336), with the maximum ventilation duration, the median was 67.0 (43.7, 108.7) hours. Hospitals in Xinjiang had the lowest rate of applying PS and INSURE, 27.3% (18/66) and 19.6% (10/51) cases respectively, but they had the largest dosage of PS (170±32) mg/kg. In Xinjiang, conventional mechanical ventilation was used as the major assisted ventilation mode (60.5%, 23/28) and the median of ventilation duration 24.0 (0.0, 60.0) hours was the shortest in the three regions. Hospitals in Gansu had the longest time of using PS, the median was 24 (7.0, 24.0) hours and also had the highest rate of applying assisted ventilation (94.6%, 139/147). The three regions had significant differences in the application of PS, mode of assistant ventilation and duration (χ(2)=40.572, 54.271, 29.529, P all<0.05). The common complications included hypoxic ischemic encephalopathy (HIE, 20.3% (104/513)), intraventricular hemorrhage (IVH,14.3%(71/498)), patent ductus arteriosus (PDA, 9.2%(48/522)), pulmonary hemorrhage (6.1%, 32/526), necrotizing enterocolitis (NEC, 4.6%(22/476)), bronchopulmonary dysplasia (BPD, 3.4%(17/502)), periventricular leukomalacia (PVL, 2.5%(12/488)), and lung leakage (1.3%, 7/531). The total mortality rate of RDS infants was 14.7% (85/580). Of the 85, 65 died after abandoning of treatment, accounting for 76.5%. The abandoning rate in Xinjiang was much higher (59.1%, 39/66) than those in Shaanxi (8.7%, 32/367) and Gansu (18.4%, 27/147). The difference was statistically significant (χ(2)=21.237, P<0.05).The infants with RDS have greater average gestational age and weight. Problems found
include incomplete prenatal examination, the high elective cesarean section rate of
full-term infants with RDS, the low antepartum application rate of antenatal steroids,
the non-standard use of PS, the low level of using INSURE, inadequate knowledge of
complications as well as underdeveloped examination methods. The abandoning of treatment
is the major cause of death. Therefore, we suggest that the government should list
pulmonary surfactant among the medical insurance covered medicines to lower the rate
of the family giving up the RDS infants because of economic difficulties.