Abstract
Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure. The goal of the present study was to develop a national database of neonatal care units and compare present outcomes data in conjunction with health care practices and costs. We summarized the above components by extracting data from the databases of the national key clinical subspecialty proposals issued by national health authority in China, as well as publicly accessible databases. Sixty-one newborn clinical units from provincial or ministerial hospitals at the highest level within local areas in mainland China, were included for the study. Data were gathered for three consecutive years (2008–2010) in 28 of 31 provincial districts in mainland China. Of the 61 newborn units in 2010, there were 4,948 beds (median = 62 [IQR 43–110]), 1,369 physicians (median = 22 [IQR 15–29]), 3,443 nurses (median = 52 [IQR 33–81]), and 170,159 inpatient discharges (median = 2,612 [IQR 1,436–3,804]). During 2008–2010, the median yearly investment for a single newborn unit was US$344,700 (IQR 166,100–585,800), median length of hospital stay for overall inpatient newborns 9.5 (IQR 8.2–10.8) days, median inpatient antimicrobial drug use rate 68.7% (IQR 49.8–87.0), and median nosocomial infection rate 3.2% (IQR1.7–5.4). For the common newborn diseases of pneumonia, sepsis, respiratory distress syndrome, and very low birth weight (<1,500 grams) infants, their lengths of hospital stay, daily costs, hospital costs, ratios of hospital cost to per-capita disposable income, and ratios of hospital cost to per-capita health expenditure, were all significantly different across regions (North China, Northeast China, East China, South Central China, Southwest China, and Northwest China). The survival rate of extremely low birth weight (ELBW) infants (Birth weight <1,000 grams) was 76.0% during 2008–2010 in the five hospitals where each unit had more than 20 admissions of ELBW infants in 2010; and the median hospital cost for a single hospital stay in ELBW infants was US$8,613 (IQR 8,153–9,216), which was 3.0 times (IQR 2.0–3.2) the average per-capita disposable income, or 63 times (IQR 40.3–72.1) the average per-capita health expenditure of local urban residents in 2011. Our national database provides baseline data on the status of advanced neonatal medicine in China, gathering valuable information for quality improvement, decision making, longitudinal studies and horizontal comparisons.
Highlights
In 2015, there were about 1.4 billion people in China, accounting for about a fifth of the world population[1]
The report from the United Nations inter-agency group for child mortality estimation shows that neonatal mortality rates in China were 30 deaths per 1,000 live births in 1990, and 6 deaths per 1,000 live births in 2015 [3]
It is well established that the decrease in neonatal mortality is explained by a number of intersecting factors such as politics, economics, culture and health beliefs, training and medical practice; advances in neonatal medicine are likely key elements of this trend
Summary
In 2015, there were about 1.4 billion people in China, accounting for about a fifth of the world population[1]. There were large discrepancies in neonatal mortality rates between urban and rural counties, and the three main diseases of birth asphyxia, preterm birth complications, and congenital abnormalities accounted for 64% of deaths in neonates in China during 2008[5,6,7]. National surveys of neonatal medicine are needed to inform neonatal health care policy and practice. National surveys of this kind have been conducted such as in America[8], and Canada [9]. There are a number of reviews and retrospective studies of neonatal medicine[13, 14], and surveys on the morbidity and mortality of neonatal respiratory failure at the Chinese national level[15, 16]. There is still a need for more comprehensive studies that gather data on issues such as staffing, investment, health care practice, and health care costs, which are key to health policy decision-making
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