Incidence and outcome of major perinatal comorbidities of all hospitalized neonates requiring intensive and critical care: a livebirth population-based survey

Prevalence, outcome and causal implication of neonatal survival-associated major morbidities remain the central focus of quality improvement of maternal-fetal and neonatal medicine. We aimed to estimate baseline information of neonatal intensive and critical care by analyzing surviving data of all hospitalized neonates from livebirth population. We prospectively collected a datafile consisting of 10,840 (13.72%) cases as all hospitalized neonates from 79,012 livebirths in Handan in 2020, a sub-provincial region with 9.41 million population and intermediate-to-high level of socioeconomic development in north China. The diagnoses of diseases requiring intensive and/or critical care, and causes of deaths, were categorized, and perinatal and disease-specific risks of death were estimated by multivariable logistic regression models. Livebirth-based incidence of major perinatal comorbidities were 19.7‰ for congenital pneumonia/early onset sepsis, 12.1‰ intraventricular hemorrhage, 8.7‰ birth asphyxia, 8.7‰ respiratory distress syndrome (RDS), 7.7‰ sepsis and 6.8‰ congenital anomalies (CA). Case-fatality rate (cause-specific mortality rate referring to livebirths) of major diseases were 47.1% (0.2‰) pulmonary hemorrhage, 26.9% (0.1‰) necrotizing enterocolitis, 15.6% (0.2‰) late onset sepsis, 14.1% (1.2‰) RDS, 11.3% (0.8‰) CA, and 11% (1.0‰) asphyxia. There were 242 (2.2%) died in hospital (3.1‰ of all livebirths), 52.1% being in the preterm, 49.2% in low birthweight, and