Prevalence and Outcome of Neonatal Respiratory Failure of All Hospitalized Neonates in Handan in 2020

Objectives We aimed to explore prevalence and outcome of neonatal hypoxemic respiratory failure (NRF) by conducting a retrospective cohort study based on a database of all hospitalized neonates from a livebirth population in Handan, a sub-provincial city/region with 9.55 million residents. Subjects and methods: From 79,012 livebirths in 2020, 10,840 (13.7%) neonates were hospitalized in 38 level II-III hospitals. Diagnosis of NRF was based on hypoxemia and requirement of non-invasive and/or intratracheal mechanical ventilation, and with intensive and/or critical care, mostly at level III hospitals. Major risk exposure for worse outcome was subjected to logistic regression analysis by integrated information of perinatal and neonatal demographic characteristics, morbidities and management. Results Prevalence of NRF was 12% with a case fatality rate of 11.8% (n = 154) in all the hospitalized, and corresponding incidence rate 16.5‰ with 2‰ mortality rate (corrected by total livebirths), respectively. With respiratory support and critical care, mostly provided at birth or first few days, mortality rate of NRF remained high at 22–30% in the extreme and very preterm infants, and 6–10% in the moderate preterm and term sub-groups. By multivariable logistic regression analysis, neonatal critical care associated co-morbidities tended to have higher perinatal death risks, whereas most of the perinatal comorbidities and neonatal complications had lowered death risks. By comparing with that of 2015 Huai’an survey, these findings revealed similar baseline status of NRF in the prevalence and outcome. Conclusion The occurrence and survival of NRF in Handan 2020 survey depicted a baseline of the morbidity and mortality, denoting eligibility and applicability, using all livebirth population-based in-hospital datafile, for estimation of efficiency of respiratory support as a core part of the regional perinatal-neonatal respiratory and critical care.