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B Ratios of median hospital cost to per-capita disposable income of local urban residents by regions, and the P -values for regional comparisons of pneumonia, sepsis, RDS, and VLBW infants were 0. C Ratios of median hospital cost to per-capita health expenditure of local urban residents by regions, and the P -values for regional comparisons of pneumonia, sepsis, RDS, and VLBW infants were 0.

During — in the five hospitals in four cities Shenyang, Shanghai, Changsha, and Tianjin , the lightest infant who survived had a birth weight of grams[ 29 ], but no infant with a gestation age of less than 25 weeks survived during this period.


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The median length of hospital stay, daily cost, and hospital cost for a single stay of hospital were Our data also showed that the treatment of ELBW infants presented economic consequences to parents. Overall, the median hospital cost of ELBW infants for a single hospital stay was 3.

We have collected comprehensive information through a national baseline database that includes indicators such as health investment, workforce, health care practice, and disease expenditure. China has made great progress in neonatal medicine in the last 30 years. Due to the availability of medical equipment such as ventilators, vital sign monitors, incubators, together with the progress in newborn nutrition, imaging and surgery, some level III hospitals in China can implement neonatal clinical technologies conducted in advanced countries[ 11 , 31 ].

And cutting-edge neonatal technologies have been successfully operated in several hospitals with high success rates, such as extracorporeal membrane oxygenation[ 32 ]. Jointly, these advances have cumulatively led to the speedy decreases in neonatal, infant and under-5 mortalities in China[ 3 — 5 , 7 , 19 ]. A big difference in China exists in the quality of tiny infant care compared with international advanced level.

However, no infants with a birth weight of less than grams or gestational age of less than 25 weeks survived in China before Although a new neonatal medicine record was established in that an infant with a birth weight of grams and gestational age of 24 weeks survived in Shenzhen, China[ 38 ], too many of the sickest newborns cannot receive successful treatments to discharge, with the result of abandonment[ 15 ].

Meanwhile, due to the varieties of gestational age at delivery and birth weight criteria for livebirth registration[ 41 , 42 ], it is very much possible that the mean birth weight and gestation age of the ELBW infants from this data are larger than that from the reports in Japan[ 40 ], America[ 43 ], and Canada[ 44 ].

The data point to a clear regional discrepancy in neonatal healthcare outcomes Fig 2.

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The report shows the huge differences in access to health services and financial protection across regions in China, such as in antenatal care coverage[ 45 ]. Reflecting the current socio-economic status of regions in China[ 21 ], most of the resources, such as high quantify-training professionals, advanced equipment and research funding, are concentrated in some metropolises, especially in the cities of Yangtze River Delta region, Pearl River Delta region, and Bohai Sea Ring Area.

This also leads to obvious disproportion in treatment effects and hospital cost as found in this study. Inadequate investment on health care in China has been long concerned. As found in this study, the total investment of less than 90 million dollars during the three years on the units with the discharge of , newborn inpatients, illustrates its serious shortage of funds.

There are reports describing the serious working environment and shortage of pediatricians and nurses in China[ 46 , 47 ]. Furthermore, there were no respiratory therapists and NICU social workers, and limited dietitians, pharmacists, and physiotherapists working in the newborn units in this study, in spite of the interdisciplinary nature of the needs of these infants. Another problem is that there is no insurance for newborn diseases in the majority of cities in China[ 48 ], and that may be one of main causes of withdrawal from treatment.

One report about outcomes for very immature newborns in China finds that The expenditures for the treatment of preterm birth in China is much less compared to some high-income countries, but it is expensive compared to the medium Chinese family income. As reported, the length of hospital stay for VLBW infants was The shortage of neonatal health staffs in China, as well as the difference in service quality, partially contribute to this fact.

But even so, the cost of ELBW infants in this dataset is three times the per-capita disposable income of local urban residents in China, or This does not include expenditures related to family stay at hospital, and the cost of other diseases resourced from preterm birth. Every Newborn Action Plan issued by The World Health Organization, provides direction for ending preventable newborn deaths worldwide[ 50 ].

Luke Jardine (Author of Essential Neonatal Medicine)

Given current situation in neonatal medicine in China, there are some priorities for the neonatal medical professionals to handle. One of urgent issues to deal with is the standardization and updating of disease management, especially in some critical diseases. In this study, variations in the length of hospital stay and disease expenditure, and the high rates of nosocomial infection and inpatient antimicrobial drug use, suggest inequalities in the provision of healthcare hospitals, cities and regions.

More applicable recommendations, clinical guidelines, clinical paths and multidisciplinary cooperation are essential for the successful management and treatment of newborn diseases.


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  • In addition, it is important to strengthen continuing education at different levels, and to develop national and regional safety and quality assessment system. There are some limitations in our study. Though the number of applicants by region and the regional ratios of newborn beds are complied with current population and socioeconomic status in China, there was no population-based sampling, and we relied on administrative data.

    Although the participating hospitals can be representatives of the highest level of neonatal medicine in China, a couple of hospitals with some strengths have missed this survey.

    Essential Neonatal Medicine

    Furthermore, while we summarize the status of advanced neonatal medicine, these results cannot be generalized to primary and secondary neonatal medicine in China. To minimize inaccuracies, we reviewed all the documents and searched well-established databases. We also collected another comprehensive dataset of research and training. In summary, this study provides a comprehensive baseline picture of neonatal medicine in China and describes a population-based database that can serve as a benchmark not only for further longitudinal and cross-sectional studies, but also provides important information to inform newborn practice and policy.

    We thank professor William D. We thank Dr. Min-Jie Zhang, and Dr. We are extremely thankful to the government agencies for the open access to the data, and to the physicians, nurses, information engineers, and other staffs to collect data from the participating hospitals.

    Conceptualization: XPL. Data curation: XPL. Funding acquisition: XPL. Investigation: XPL. Project administration: XPL. Resources: XPL. Software: XPL. Visualization: XPL. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure.

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    Introduction In , there were about 1. Methods Data sources We extracted data from documents submitted as part of a request for proposals issued in by The Ministry of Health of the People's Republic of China MOH for projects aiming to evaluate and develop national key clinical subspecialty indicators in mainland China. Download: PPT. Procedures Proposals submitted in response to the request for proposals, and commitments of data authenticity were included in the study.

    Indicators We examined tertiary neonatal data for the years , , and , including newborn health infrastructure, workforce, health service, and disease expenditure. Analysis First we conducted descriptive statistics to explore the distribution and frequencies of results. Table 1.

    Essential Neonatal Medicine (Essentials)

    Newborn unit investment, workforces and health care activities in 61 hospitals during — Newborn health workforce The median number of physicians per newborn unit was 22 IQR 15—29 , with a total of 1, across the 61 hospitals. Inpatient discharges and length of hospital stay During —, there was a total discharge of , newborn inpatients, and the overall inpatient discharges increased by Table 2.

    Disease expenditure of a single hospital stay for common newborn diseases during — Cutting-edge neonatal technologies and quality Advanced incubators and ventilators, cardio-respiratory monitors, magnetic resonance imaging, and cardiac echocardiography, were commonly reported in most of the hospitals. Disease expenditure During the three years, the length of hospital stay, daily cost, and hospital cost for common newborn diseases of pneumonia, sepsis, RDS, and VLBW infants, were specifically reported, and they all varied significantly across regions Table 2 , but not across hospital types.

    Fig 2. Disease expenditures of four common newborn diseases by regions during — Extremely low birth weight ELBW infants During — in the five hospitals in four cities Shenyang, Shanghai, Changsha, and Tianjin , the lightest infant who survived had a birth weight of grams[ 29 ], but no infant with a gestation age of less than 25 weeks survived during this period. Progress in neonatal medicine in China China has made great progress in neonatal medicine in the last 30 years.

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    Comparisons of survival rates between countries A big difference in China exists in the quality of tiny infant care compared with international advanced level. Regional discrepancy in China The data point to a clear regional discrepancy in neonatal healthcare outcomes Fig 2. Economic impacts of preterm birth The expenditures for the treatment of preterm birth in China is much less compared to some high-income countries, but it is expensive compared to the medium Chinese family income.

    Suggested policies for neonatal medicine in China Every Newborn Action Plan issued by The World Health Organization, provides direction for ending preventable newborn deaths worldwide[ 50 ]. Study limitations There are some limitations in our study. Conclusions In summary, this study provides a comprehensive baseline picture of neonatal medicine in China and describes a population-based database that can serve as a benchmark not only for further longitudinal and cross-sectional studies, but also provides important information to inform newborn practice and policy.