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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.

Introduction: To determine the epidemiology of blood culture-positive late-onset sepsis (LOS, >72 hours of age) in 44 Malaysian neonatal intensive care units (NICUs). Materials and Methods: Study Design: Multicentre retrospective observational study using data from the Malaysian National Neonatal Registry. Participants: 739486 neonates (birthweight ≥500g, gestation ≥22 weeks) born and admitted in 2015-2020. Results: LOS developed in 2707 (0.4%) neonates. Median annual incidence (per 100 admissions) was 12.0 (range: 8.1-13.8) in extremely preterm (EPT, gestation <28 weeks), 5.3 (range: 5.0-6.8) in very preterm (VPT, gestation 28-<32 weeks), 0.5 (range: 0.4-0.7) in moderate/late preterm (gestation 32-<37 weeks) and 0.1 in term (gestation ≥37 weeks) neonates. Gram-negative bacteria accounted for 54.7% of pathogens isolated, gram-positive bacteria 39.3%, and fungal and other pathogens 6.0%. The six most common pathogens were coagulase-negative Staphylococcus (18.3%), Klebsiella spp. (18.3%), Staphylococcus aureus (9.9%), Pseudomonas spp. (8.9%), Acinetobacter spp. (7.7%) and Escherichia coli (5.9%). LOS-attributable mortality was 14.3% in EPT, 9.3% in VPT, 8.3% in LPT and 6.2% in term neonates. Multiple logistic regression analysis showed that EPT, small-for-gestation (SGA), conventional mechanical ventilation (CMV), high frequency ventilation (HFV), TPN and use of central venous lines (CVL) were significant independent risk factors associated with LOS in neonates <32 weeks' gestation. The significant independent risk factors associated with mortality in neonates with LOS were SGA, CMV, HFV, gram-negative sepsis, fungal sepsis, and pneumothorax. Conclusion: Gram-negative bacteria were the commonest pathogens. Decreasing the usage of invasive ventilation, CVL and TPN may reduce the incidence and mortality of LOS, particularly in neonates <32 weeks gestation. [ABSTRACT FROM AUTHOR]

Background: Information on incidence and risk factors associated with different types of neonatal pneumothorax were lacking globally. Objectives: To determine incidences of pneumothorax developed spontaneously and during different modes of respiratory support, and risk factors associated with each type of pneumothorax. Study Design: Retrospective observational study of neonates in the Malaysian National Neonatal Registry. Setting: 44 Malaysian neonatal intensive care units (NICUs). Participants: All neonates born in 2015-2020 and admitted to NICUs. Results: Pneumothorax developed in 3265 neonates: 37.5% occurred spontaneously, 62.5% during respiratory support. The incidence of all types of pneumothorax was 1.75 per 1000 livebirths, and of spontaneous pneumothorax was 0.58 per 1000 livebirths. Pneumothorax developed in 0.6% (450/70512) of neonates during continuous positive air way pressure therapy (nCPAPt), 1.8% (990/54994) of neonates during conventional mechanical ventilation (CMV), and 7.0% (599/8557) of neonates during high frequency ventilation (HFV). Term neonates had significantly higher pneumothorax rate than preterms (p<0.001). Multiple logistic regression analyses show that exposure to intermittent positive pressure ventilation and chest compression at birth were significant independent factors associated with increased risk of spontaneous pneumothorax and CMV, and persistent pulmonary hypertension was associated with increased risk of spontaneous pneumothorax and pneumothorax during CMV and HFV. Conclusions: The most common type of pneumothorax was spontaneous in-onset. Neonates on HFV had the highest and those on nCPAPt the lowest rate of pneumothorax. Improving training of resuscitation techniques at birth and strategies of use of invasive modes of respiratory support may reduce incidences of all types of pneumothorax. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence, causative pathogens, morbidities, mortality, and risk factors associated with blood culture-positive early-onset sepsis (EOS, ≤72 hours of age) in symptomatic neonates admitted to the neonatal intensive care units (NICUs) of a middle-income country. Study Design: Retrospective cohort study using data submitted prospectively to the Malaysian National Neonatal Registry (MNNR). Setting: 44 Malaysian NICUs. Participants: All neonates born in 2015- 2020. Results: EOS was reported in 991 neonates. The annual incidence of EOS increased from 0.46 to 0.49/1000 livebirths over the six years. The most common pathogen was Streptococcus agalactiae or Group B haemolytic streptococcus (GBS) (n=388, 39.2%), followed by Escherichia coli (E. coli) (n=80, 8.1%), Klebsiella spp (n=73, 7.4%), coagulase negative staphylococcus (CONS) (n=73, 7.4%), Pseudomonas spp (n=44, 4.4%) and methicillin-sensitive Staphylococcus aureus (n=34, 3.4%). The incidence of EOS due to GBS increased from 0.17 to 0.22/1000 livebirths. Morbidities and mortality were higher in those with EOS than without EOS. Multiple logistic regression analysis showed that Indian ethnic group, chorioamnionitis, gestation≥37weeks, female, spontaneous vaginal delivery, instrumental delivery, and surfactant therapy were significantly associated with increased risk of EOS due to GBS. Four factors were significantly associated with increased risk of non-GBS EOS (outborns, birthweight <1000 g, vaginal delivery, and surfactant therapy). Early continuous positive airway pressure was associated with significantly lower risk of EOS. Conclusion: The incidence of EOS showed an increasing trend in Malaysian NICUs. GBS was the most common causative pathogen. Several modifiable risk factors associated with EOS have been identified. [ABSTRACT FROM AUTHOR]