加强低体重儿管理降低死亡率的调查分析

随着围产医学的发展,低体重儿的成活率已有了明显的提高。但仍是新生儿死亡的重要原因之一。我院产科加强对低体重儿的系统管理．使死亡率逐年下降．现将三年来低体重儿的情况分析如下：1临床资料11一般资料自1993年至1995年三年中共出生新生儿7互17名;低体重儿（＜2500g）564人,占7.92%其中早产儿394例（69.84％）．足月小样儿170例（30.14％）体重最小950g．胎龄最小为28周．三年共死亡新生儿89人新生儿死亡率12.5%．其中低体重儿62人,占696.6%。1.2三年中低体重儿死亡率的比较1993年出生低体重儿175人,死亡30人,死亡率为171．4‰,…     

哈尔滨市1997～2003年新生儿主要死因的变化趋势分析

目的 掌握哈尔滨市新生儿死亡变化趋势，及时调整降低新生儿死亡率的措施。方法对哈尔滨市1997～2003年新生儿死亡的资料进行分析。结果7年来哈尔滨市新生儿死亡率显著下降，1997年新生儿死亡率全市9．59‰、城市8.80‰、农村10.60‰；2003年新生儿死亡率全市5.86‰、城市4．99‰、农村6．17‰。每年早产和低出生体重和出生窒息为新生儿死亡第一住和第二位，先天性心脏病和畸形将成为新生儿死亡主要原因。结论降低新生儿死亡率，关键要降低出生窒息的死亡率，提高早产儿、低出生体重儿的预防、监护和治疗水平，提高产前诊断技术和先天性心脏病的诊治水平。     

多胎新生儿临床流行病学调查

目的：为了解嘉兴地区代表性的多胎新生儿发生情况。方法：调查1995年1月1日－1998年12月31日嘉兴市妇幼保健院出生的活婴中的多胎新生儿。结果 ：（1）多胎妊娠发生率分别为双胎12．91‰，三胎032‰，四胎0．06‰。（2）双胎新生儿45．05％为早交和，59．16％为低体重儿（包括极低体重儿和超极低体重儿）；三胎，四胎新生儿全部为早产，低体重儿。（3）窒息发生率为40．66％，其中双胎38．61％，三胎86．67％，四胎75％；重度窒息发生率6．62％。75．41％的多胎儿采取择期剖宫产。（4）新生儿为是多胎新生儿最常见疾病。患病率55．56％。先天畸形发生率8．51％，其中体表畸形占58．33％。（5）新生儿期病死率28．37‰，双胎27．23‰，三胎66．67‰，四胎全部存活。最主要的死因是早产，极低体重儿，重度窒息，占58．33％。一后24小时内病死者占83．33％，放弃抢救死亡者占66．67％。（6)多胎妊娠孕母合并症发病率89．42％，最常见的是妊娠高血压症，发病率52．88％。结论：双胎，三胎妊娠发生率接近发达国家资料。随着胎儿数增加，多胎新生儿早产，低体重儿，窒息和孕母妊娠合并症发生率增高。双胎，三胎新生儿病死率均高于发达国家。采用B超，彩超早期诊断多胎妊娠，健全围产保健，开展择期剖宫产，进一步加强爱婴医院新生儿科建设是减少多胎妊娠并发症，提高多胎新生儿存活率的有效措施。     

珠海市斗门县1996～2001年新生儿死亡监测及对策

目的：为降低珠海市斗门县新生儿死亡率提供科学依据，以便制定行之有效的策略与措施。方法：对1996—200l年全县按要求上报的新生儿死亡监测资料进行综合分析。结果：其间活产数为113475例，新生儿死亡1380例，新生儿死亡率为12．16‰；死亡的前5位死因及顺位依次为；早产儿和低出生体重儿、新生儿窒息、新生儿肺炎、新生儿破伤风、新生儿颅内出血。结论：做好孕产妇系统管理，提高新法接生率和住院分娩率，加强产、儿科协作，加强围产期及新生儿期医疗保健知识的宣传，搞好新生儿疾病适宜技术的培训，提高妇幼卫生人员服务能力等是降低新生儿死亡率的根本措施。     

涪陵区儿童脑性瘫痪现况调查分析

目的了解本地区0～6岁儿童脑性瘫痪(简称脑瘫)患病状况及相关因素。方法调查2个乡镇0～6岁儿童3 360名。调查内容、方法、筛查标准和诊断标准均按"全国小儿脑瘫流行病学及病因学研究"方案进行。结果本区0～6岁儿童脑瘫患病率为5.06‰(17/3 360)。男童患病率高于女童,差异有统计学意义(P<0.05);异常出生孕周及异常出生体质量儿脑瘫发生率高于正常出生孕周及体质量儿脑瘫发生率,且差异有统计学意义(P<0.05);脑瘫患儿中新生儿窒息、新生儿黄疸及早产低出生体质量构成比较高。结论新生儿窒息、新生儿黄疸、早产低出生体质量可能是本地区儿童脑瘫的危险因素。     

青海省2002-2006年5岁以下儿童死亡监测分析

目的为准确掌握青海省5岁以下儿童的死亡情况，以制定有效的干预措施，降低全省5岁以下儿童死亡率。方法按照《青海省5岁以下儿童监测方案》要求，以妇幼三级保健网为依托，对青海省西宁市城东区及9个项目县共10个监测点2002～2006年出生的活产数及5岁以下儿童死亡情况进行全面监测。结果5年间婴儿死亡率为30．11‰，5岁以下儿童死亡率为33．67％。，新生儿及婴儿死亡占5岁以下儿童死亡的比例分别为63．98％、89．13％，新生儿及婴儿死因顺位均为肺炎、出生窒息、早产及低出生体重，1～4岁儿童死因顺位为肺炎、意外及中毒、腹泻。结论青海省新生儿、婴儿及5岁以下儿童死亡率呈逐年下降趋势，2003年较2002年婴儿死亡略有上升，因此加强新生儿肺炎的防治，减少新生儿窒息、早产及低出生体重的发生是关键。     

提高农村出生低体重儿存活率措施的探讨

目的:探索提高农村出生低体重儿存活率的措施对降低婴儿死亡率的作用。方法:基层保健机构建立农村高危妊娠转诊、会诊、抢救中心和新生儿专科,对出生低体重儿重点监护。从2002～2003年重点监护以后,与2000～2001年比较两纽出生低体重儿的存活率、并发症的病死率、全市婴儿死亡率,资料均经统计学处理。结果:设立新生儿专科前,收住出生低体重儿42例:胎龄28～38周,体重1.0～2.0kg。设立新生儿专科以来,2002～2003年期间,我院收住出生低体重儿142例,胎龄27～28周,体重在0.9～2.0kg。显示两组胎龄、出生体重构成比较,无差异(P>0.05),具可比性。出生低体重几住院存活率由原来54.76％提高到97.18％;全市婴儿死亡率由原来16.67％降至1446％。前后差异均有显著性意义(P<0.05)。结论:在基层保健机构设立农村高危妊娠转诊中心,配套设立新生儿专科,建立重症监护,加强医护人员专科技能培训。提高医护人员对重症监护的整体业务水平,提高出生低体重儿的存活率,对降低婴儿死亡率起到关键性作用。     

253例低出生体重儿临床资料分析

目的探讨影响低出生体重儿存活率的相关因素,为降低其死亡率提供帮助。方法对本医院近5年收治的253例低出生体重儿的临床资料进行回顾性研究分析,对其生存和死亡进行分析比较。结果低出生体重儿主要原因有羊膜早破36(14．23％),脐带异常35(13．83％),胎盘早剥26(10．28％),双胎妊娠16例(6．32％)。主要的并发症有新生儿肺炎97(38.3％),窒息68(26．9％),硬肿症54(21.3％),缺氧缺血性脑病51(20．2％),脐炎47(18．6％),呼吸窘迫综合征35(13．8％),消化道出血30(11．9％),颅内出血29(11．5％)等等。低出生体重儿并发症发生率、死亡率与胎龄、出生Apgar评分及出生体重呈负相关系。死亡的主要原因是呼吸衰竭15例(39．5％),DIC与肺出血6例(15．8％),颅内出血与脑水肿8例(21．1％)。结论为了预防低出生体重儿必须加强产前检查和监护,对所有的低出生体重儿必须密切监护,早期发现并发症,及时处理,防止院内感染,以提高低出生体重儿的存活率,减少后遗症。     

低出生体重儿的护理体会

低出生体重儿是指出生1h内测体重,体重不足2500g的新生儿,不论胎龄大小、成熟程度统称低出生体重儿。低出生体重儿包括早产儿、胎龄在37～42周的足月小于胎龄儿及胎龄在42周以上的胎盘功能不全的过期产儿。低出生体重儿各器官的形态和生理功能均未成熟,生理功能低下,适应性和抵抗力差,死亡率较正常新生儿高,只有给予科学的护理．才能提高低出生体重儿的存活率,现将护理体会报告如下。     

浅析低体重儿的护理

低体重儿临床死亡率是很高的。据国内统计34-37周出生的死亡率为38‰,38-42周出生的死亡率为54‰,胎令超过42周的死亡率达54‰因此在护理上较正常新生儿要求更细微。对患病的低体重儿,还需要我们结合其特点严密观察病情做好各项护理工作。 我们对1990年12月8日入院的一例足月顺产体重1700g,感染肺炎伴呼吸衰竭合并败血症的患儿进行了严密观察护     

Surfactant therapy in respiratory distress syndrome: The effect of a learning curve in improving outcome

A retrospective study of all premature neonates who received artificial surfactant (Curosurf) at the Rotunda Hospital was performed. The period from October 1990 to June 1992 (n=48) was compared with the initial experience from June 1987 to January 1988 (n=15). In the initial period mortality rate was 67% in surfactant treated infants, and use of surfactant was not associated with an improvement in outcome compared with the previous six years. In the more recent period overall mortality was 21%. Overall survival in normally formed very low birthweight infants improved from 59% in 1986 to 86% in 1991–1992. Improvement in survival rates was most noticeable in infants with birthweight 750–999 grams, with survival increasing from 44% (before introduction of surfactant treatment) to 91% (in1991–1992). It is probable that a certain level of experience with use of surfactant is required before optimal effects can be obtained.     

Why have we failed to reduce the frequency of cerebral palsy?

OBJECTIVE: To review the data on children with cerebral palsy in relation to quality of obstetric care. DATA SOURCES and STUDY SELECTION: In our Institute, a regular Medline print-out, certain key journals and Current Contents are perused to create an updated computerised file of publications on the epidemiological, aetiological and other aspects of cerebral palsy. For this study we reviewed data from the Western Australian Cerebral Palsy Register, more than 150 publications from which studies were chosen for sound methodology in countries with modern obstetric practices, and recent population data on cerebral palsy. DATA EXTRACTION and SYNTHESIS: Three major areas were studied to see: (i) if the prevalence of cerebral palsy has fallen with increasing use of obstetric and neonatal interventions aimed at reducing birth asphyxia; (ii) if there is any evidence that cerebral palsy is caused by birth asphyxia; and (iii) if there is any evidence that intrapartum fetal monitoring or caesarean section reduces the prevalence of cerebral palsy. CONCLUSIONS: We concluded that: cerebral palsy proportions are not falling in spite of significant increases in obstetric and neonatal interventions aimed at reducing asphyxia; cerebral palsy proportions in low birthweight infants are rising in most developed countries, coincident with increases in the neonatal survival of low birthweight babies; few cases of cerebral palsy seem to be caused by birth asphyxia and those that are may not have been preventable by obstetric care; and parents will continue to sue if obstetricians keep promising perfection from obstetric care in the face of 2.0-2.5 cases of cerebral palsy per 1000 children born.     

98例早产儿死亡原因分析

目的 分析安徽省立医院新生儿科近4年住院早产儿死亡原因,为降低早产儿病死率提供防治措施。 方法 通过收集安徽省立医院2013年1月1日-2016年12月31日新生儿科98例死亡早产儿的性别、出生方式、出生胎龄、出生体重、死因等资料进行回顾性分析。 结果 ①近4年住院早产儿共2 794例,死亡98例,总病死率为3.51%(98/2 794);各年病死率分别为2013年4.36%(25/573)、2014年3.79%(24/633)、2015年3.48%(23/660)、2016年2.80%(26/928);早产儿总数呈渐增趋势,病死率总体呈下降趋势,但各年间病死率差异无统计学意义。②不同胎龄间死亡早产儿病死率比较,差异有统计学意义(P<0.05);不同体重间病死率比较,差异有统计学意义(P<0.05);早产儿出生胎龄越小、体重越低,病死率越高。③早产儿主要死因顺位前5位为肺透明膜病27.55%(27/98)、感染性疾病20.41%(20/98)、窒息14.29%(14/98)、先天性出生缺陷11.22%(11/98)、肺出血9.18%(9/98)。 结论 该院早产儿死亡主要原因与早产儿胎龄、体重以及肺透明膜病、感染性疾病、窒息、先天性出生缺陷、肺出血等并发症有密切关系;可通过加强产前筛查和围生期保健、提高早产儿窒息复苏抢救水平、加强早产儿呼吸道管理和感染的防控,从而降低早产儿病死率。      

Methods of delivery and resuscitation of very-low-birthweight infants in Victoria: 1982-1985

This article describes the patterns of delivery and resuscitation for very-low-birthweight infants who were born in Victoria from 1982 to 1985. Caesarean delivery rates increased from 15% to 30% for infants of birthweights of 500-999 g, and from 39% to 52% for infants of birthweights of 1000-1499 g. In level-III hospitals, the proportion of live-born infants who did not receive active resuscitation fell from 32% to 18% for those who weighed 500-999 g, and from 28% to 15% for those who weighed 1000-1499 g. Time trends over the four years showed the management of very-low-birthweight infants to be in a state of rapid transition in all birth settings. At the same time there was a fall in the still-birth rate of infants of birthweights of 500-999 g. Still-births rates for infants of birthweights of 1000-1499 g remained unchanged, as did neonatal mortality rates in both weight groups.     

Postponing or preventing deaths? Trends in infant survival, Georgia, 1974 through 1981

Trends in survival were examined for infants in five birth-weight groups (500 to 999 g, 1,000 to 1,499 g, 1,500 to 1,999 g, 2,000 to 2,499 g, and greater than or equal to 2,500 g). The study population consisted of infants born in Georgia from 1974 through 1981. Survival to the first birthday increased for all birthweight groups. Improvements in postneonatal survival occurred concurrently with improvements in neonatal survival, except for infants with birth weights of 500 to 999 g. Between 1974-1975 and 1980-1981, the proportion of deaths that were attributed to perinatal conditions but occurred during the postneonatal period increased from 1.1% to 4.7%. These observations suggest that advances in perinatal care have led to postponement rather than prevention of a few infant deaths, although overall many more deaths were prevented. For infants with birth weights of less than 1,500 g, lower mortality among those admitted to newborn intensive care units was the major contributor to improved survival. Our findings indicate that both neonatal and postneonatal mortality should be examined in evaluating the effects of perinatal care.     

The impact of the establishment of a neonatal intensive care unit on the outcome of very low birthweight infants at the University Hospital of the West Indies

A retrospective analysis of the outcome of inborn very low birthweight infants admitted to the neonatal unit of the University Hospital of the West Indies pre- (period 1) and post- (period 2) establishment of a neonatal intensive care unit was conducted. During the study, 250 infants were admitted to the neonatal unit, 132 (53%) during period 1 and 118 (47%) during period 2. There was improved survival during period 2 when 81 (69%) infants survived compared to period 1 when 73 (55%) survived (p = 0.02). This increased survival was due to an increase in survival of infants weighing 750-999g in period 2 when 17 (65%) infants survived compared to 9 (29%) in period 1 (p < 0.05). There was an increase in the number of infants ventilated in period 2, 39 (33%) compared to 12 (9%) period 1 (p < 0.001). Infants who were ventilated in period 2 were less likely to die than those ventilated in period 1 (OR 0.05, CI 0.01, 0.66). After controlling for gender, weight, gestational age and ventilation, infants born in the second time period were less likely to die than those born in the first time period (OR 0.33, CI 0.14, 0.76). The establishment of a neonatal intensive care unit has resulted in improved survival of very low birthweight infants; further improvement in survival of these infants will be dependent on increased accessibility to surfactant therapy, initiation of total parenteral nutrition and availability of trained personnel.     

广西11万1—6岁小儿脑性瘫痪患病状况调查分析

目的 通过广西部分市县小儿脑性瘫痪（简称脑瘫）的试点调查,为全省范围的调查及防治工作打下基础。方法 采用整群抽样法在横县、钦州抽取２４个乡（镇）为样本区,由通过专业培训的人员按统一诊断标准,对样本区１～６岁小儿进行脑性瘫痪的患病状况调查。结果 共调查１１４９５２人,脑瘫１５２例,脑瘫患病率为１．３３‰,其中男性１１１例,占７３％,女性４１例占２７％。结论 广西两县１１万１～６岁小儿脑瘫患病率与国内     

A 2-year study of neonatal mortality in a large Malaysian hospital

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.     

Strategies for reduction of neonatal mortality

Summary  Infant mortality rates in developed countries have shown significant decreases in recent years. Two-thirds of infant mortality still occurs in the neonatal period and our aim in this study was to review the causes of these neonatal deaths and see where further improvements may be possible. A 6-yr review of all neonatal deaths of live-born infants over 500g birthweight from 1991 to 1996 was made. The 1989 amended Wigglesworth classification was used to categorise cause of death and other perinatal variables were also recorded. Results show there were 34,375 births and 153 neonatal deaths. Classification of these deaths by Wigglesworth found 78 (51 per cent) due to congenital malformations, 58 (38 per cent) due to prematurity, 6 (4 per cent) due to asphyxia and 11 (7 per cent) due to specific other causes. The corrected neonatal mortality was 2.18. Neural tube defects alone accounted for 10 per cent of the total neonatal mortality. Fifty-five out of 58 infants who died due to prematurity had birthweight < 1000g and survival rates in this group compared well to international standards. We conclude that a reduction in neonatal mortality is possible but is most likely to result from community focused measures such as increased use of pre- and peri-conceptional folate.