A Cross-Sectional Nationwide Study on Accessibility and Availability of Neonatal care Resources in Hospitals of China: Current Situation, Mortality and Regional Differences

The Lancet Regional Health. Western Pacific

Zhichun Feng, MD¹  Yuan Shi, MD²  Chao Chen, MD³  Xiaoyu Zhou, MD⁴  Bin Yi, MD⁵  Shaoru He, MD⁶  Ling Liu, MD⁷  Ling Yang, MD⁸  Li Ma, MD⁹  Yangfang Li, MD^1,10  Shiwen Xia, MD^1,11  Xianmei Lu, MD^1,12  Kezhan Liu, MD^1,13  Jian Mao, MD^1,14  Hua Mei, MD^1,15  Zhuying Wang, MD^1,16  Yang Wang, MD^1,17  Danni Zhong, MD^1,18  Li Liu, MD^1,19  Mingxia Li, MD^2,20  Xiuyong Cheng, MD^2,21  Xiao Chen, MD^2,22  Chaoying Yan, MD^2,23  Hong Wu, MD^2,24  Zhenlang Lin, MD^2,25  Qiuping Li, MD^2,26  Xing Li, MD^2,26  Qian Zhang, MD^2,26  Yanping Zhang, MD^2,26  Jun Zheng, MD^2,27  Jun Tang, MD^2,28  Xiaorong Wang, MD^2,29  Xinzhu Lin, MD^3,30  Shaojie Yue, MD^3,31  Yanxiang Chen, MD^3,32 

[1] Corresponding Author: Yuan Shi, Department of Neonatology, the Ministry of Education Key Laboratory of Child Development and Disorders;Children's Hospital of Chongqing Medical University;Children's Hospital of Fudan University;Children's Hospital of Nanjing Medical University;Gansu Provincial Maternity and Child-care Hospital;Guangdong Academic of Medical Sciences/ Guangdong Provincial People's Hospital;Guiyang Maternal and Child Health Care Hospital;Hainan Women and Children's Medical Center;Hebei Provincial Children's Hospital;Kunming Children‘s Hospital;Maternal and Child Health Hospital of Hubei Province;Shandong University Qilu Hospital;Shanxi Province Children's Hospital;Shengjing Hospital of China Medical University;The Affiliated Hospital of Inner Mongolia Medical University;The First Affiliated Hospital Of Harbin Medical University;The First Affiliated Hospital of Anhui Medical University;The First Affiliated Hospital of Guangxi Medical University;The First Affiliated Hospital of Xi'an Jiaotong University;The First Affiliated Hospital of Xinjiang Medical University;The First Affiliated Hospital of Zhengzhou University;The First Affiliated Hospital to Nanchang University;The First Hospital of Jilin University;The People's Hospital of the Tibet Autonomous Region;The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical Univeristy;The Seventh Medical Center of the Chinese PLA General Hospital;Tianjin Central Hospital of Obstetrics and Gynecology;West China Second University Hospital of Sichuan University;Women Children Hospital of Qing Hai;Women and Children's Hospital of Xiamen University School of Medicine;Xiangya Hospital of the Central South University;Yinchuan No.1 People's Hospital of Ningxia;

关键词: 新生儿重症监护;    资源;    死亡率;    调查;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: To investigate the current situation of neonatal care resources (NCR), newborn mortality rates (NMR), regional differences and existing challenges in China. Methods: By using a self-designed questionnaire form and the cross-sectional method, we conducted a survey of all hospitals equipped with neonatal facilities in China from March 2019 to March 2020 with respect to the level and nature of these hospitals, the number of newborn beds and NICU beds, the number of neonatal pediatricians, and the development of therapeutic techniques. The data about the newborn births and deaths were retrieved from the annual statistics of the health commissions of the related provinces, autonomous regions and municipalities. Finding: Included in this nationwide survey were 3,020 hospitals from all 22 provinces, 5 autonomous regions and 4 municipalities directly under the Central Government of Mainland China, with a 100% response rate. They included 1,183 (39.2%) level-3 (L3) hospitals, 1629 (53.9%) L-2 hospitals and 208 (6.9%) L-1 hospitals. Geographically, 848 (31.4%) hospitals were distributed in Central China, 983 (32.5%) hospitals in East China, and 1,089 (36.1%) in West China. The 3,020 included hospitals were altogether equipped with 75,679 newborn beds, with a median of 20 (2-350) beds, of which 2,286 hospitals (75.7%) were equipped with neonatal intensive care units (NICU), totaling 28,076 NICU beds with a median of 5 (1-160) beds. There were altogether 27,698 neonatal pediatricians in these hospitals, with an overall doctor-bed ratio of 0.366. There were 48.18 newborn beds and 17.87 NICU beds per 10,000 new births in China. In East, Central and West China, the number of neonatal beds, NICU beds, neonatal pediatricians, and attending pediatricians or pediatricians with higher professional titles per 10,000 newborns was 42.57, 48.64 and 55.67; 17.07, 18.66 and 18.17; 16.26, 16.51 and 20.81; and 10.69, 10.81 and 11.29, respectively. However, when the population and area are taken into consideration and according to the health resources density index (HRDI), the number of newborn beds, NICU beds and neonatal pediatricians in West China was significantly lower than that in Central and East China. In addition, only 10.64% of the neonatal pediatricians in West China possessed the Master or higher degrees, vs. 31.7% in East China and 20.14% in Central China. On the contrary, the number of neonatal pediatricians with a lower than Bachelor degree in West China was significantly higher than that in Central and East China (13.28% vs. 7.36% and 4.28%). Technically, the application rate of continuous positive airway pressure (CPAP) and conventional mechanical ventilation (CMV) in L-1 hospitals of West China was lower than that in Central and East China. According to the statistics in 2018, the newborn mortality rate (NMR) in West China was significantly higher than that in Central and East China. Interpretation: China has already possessed relatively good resources for neonatal care and treatment, which is the primary reason for the rapid decrease in the NMR in China. However, there are still substantial regional differences. The density of health resources, the level of technical development and educational background of neonatal pediatricians in West China still lag behind those in other regions of China and need to be further improved and upgraded. Funding: This research work was funded by National Natural Science Foundation of China (81671504) and United Nations International Children's Emergency Fund (CHINA-UNICEF501MCH). 【摘要】: 目的 了解中国新生儿救治资源及新生儿死亡率现状,地区差异及存在的挑战.方法 2019年3月至2020年3月, 设计调查表格, 采取横断面调查方式, 对全国设置有新生儿床位的医院进行调查, 内容包括医院级别,性质,新生儿床位,NICU床位数,新生儿医师数量及救治技术开展情况等.新生儿出生数和死亡率来源于各省卫生健康委年度统计数据.结果 共纳入除港澳台地区外全国31个省3020家医院, 反馈率100%, 其中三级医院1183家 (39.2%), 二级医院1629家 (53.9%), 一级医院208家 (6.9%) .按地区分布, 中部地区948家 (31.4%), 东部983家 (32.5%), 西部1089家 (36.1%) .3020家医院共有新生儿床位75679张, 床位中位数20张 (2-350张), 其中2286家 (75.7%) 医院设置有NICU床位共28076张, NICU床位中位数为5张 (1-160张), 共拥有新生儿科医师27698人, 总医/床比为0.366.全国每万名出生新生儿拥有新生儿床位48.18张, 其中NICU床位17.87张.东部,中部,西部每万名出生新生儿拥有新生儿床位数分别为42.57张,48.64张和55.67张, 其中NICU床位分别为17.07张, 18.66张和18.17张, 拥有新生儿科医师分别为16.26人,16.51人和20.81人, 其中主治医师以上分别为10.69人,10.81人和11.29人.但如考虑到人口和面积, 按HRDI指数计算, 西部地区新生儿床位,NICU床位及新生儿科医师人数仍明显低于东,中部地区.且西部地区新生儿科医师中拥有硕士以上学历者仅10.64%, 明显低于东部 (31.7%) 和中部 (20.14%), 而本科以下学历比例为13.28%, 远高于东部 (4.28%) 和中部地区 (7.36%) .从技术开展情况看, 西部地区一级医院在CPAP,常频通气等技术开展率低于东,中部地区.西部地区2018年新生儿死亡率也明显低于东,中部地区.结论 中国已拥有较好的新生儿医疗救治资源, 这是新生儿死亡率得以迅速下降的基础.但地区差异仍较大, 西部地区卫生资源密度,技术发展水平和医师学历仍相对滞后, 需要进一步加强.

【 授权许可】

Unknown