Asian Neonatal Network Collaboration (AsianNeo): a study protocol for international collaborative comparisons of health services and outcomes to improve quality of care for sick newborn infants in Asia - survey, cohort and quality improvement studies

Abstract

Introduction: Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants.

Methods and analysis: Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions).

Ethics and dissemination: The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020-244, 2022-156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

Keywords: International health services; Mortality; NEONATOLOGY; Neonatal intensive & critical care.

Figure 1. Asian Neonatal Network Collaboration countries or regions.

Figure 2. Availability of treatment and diagnostic tests. The information in the table is based on the personal understanding of the steering committee members regarding NICU care in their respective countries. The words of ‘Mostly’, ‘Often’, ‘Sometimes’, ‘Rarely’ and ‘Never’ indicate the proportions of 80–100%, 50–79%, 20–49%, 1–19%, and <1 %, respectively. *Available only in level-III NICUs. aEEG, amplitude-integrated electroencephalogram; CO₂, carbon dioxide; CPAP, continuous positive airway pressure; HFO, high-frequency oscillation; SpO2, oxygen saturation.

Figure 3. Cause of death algorithm. abn, abnormality; ARD, acute respiratory distress; CLD, chronic lung disease; FIP, focal intestinal perforation; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis.