2010—2017年住院新生儿疾病构成及死因分析

目的：了解近8年温州医科大学附属第二医院育英儿童医院（以下简称我院）新生儿科收治疾病病种及死亡原因。方法：回顾性分析2010—2017年我院新生儿科住院疾病构成，比较前后4年主要疾病发生率以及病死率变化。结果：8年共收治新生儿25 632例。新生儿总体病死率由前4年的2.19%降至后4年的1.66%（P=0.001）；其中，胎龄＜28周病死率（25.32% vs. 15.77%，P=0.022），胎龄≥37周新生儿病死率（1.64% vs. 1.02%，P＜0.001）下降显著。前后4年比较，新生儿呼吸窘迫综合征（9.43% vs. 10.76%，P＜0.001）、支气管肺发育不良（2.05% vs. 3.40%，P＜0.001）、早产儿视网膜病变（1.51% vs. 2.82%，P＜0.001）、新生儿坏死性小肠结肠炎（1.25% vs. 1.90%，P＜0.001）、脑白质软化（0.77‰ vs. 2.57‰，P=0.001）等早产儿并发症发生率增加；先天性心脏病（16.97% vs. 19.72%，P＜0.001）、消化道/腹部畸形（4.19% vs. 5.13%，P=0.001）等出生缺陷发生率增加；新生儿窒息（5.12% vs. 3.33%，P＜0.001）、新生儿缺氧缺血性脑损伤（2.74% vs. 1.46%，P＜0.001）发生率下降。前后4年比较，住院新生儿感染病死率下降（0.89% vs. 0.21%，P＜0.001）；早产儿坏死性小肠结肠炎病死率（30.95% vs. 17.26%，P=0.008）及败血症病死率（3.07% vs. 1.15%，P=0.014）显著下降。试管婴儿平均胎龄[（32.67±0.12）周]，较自然受孕患儿[（36.99±0.02）周]小，试管婴儿病死率较自然受孕患儿高（4.26% vs. 1.79%，P＜0.001），差异均有统计学意义。结论：2010—2017年我院新生儿总体病死率及感染性疾病病死率呈下降趋势。随着超早早产儿存活率升高，防治早产儿并发症成为早产儿管理的重点。住院患者中试管婴儿平均胎龄较自然受孕患儿低，而病死率较高。出生缺陷发生率升高，且成为主要死因之一。

An analysis of neonatal diseases and causes of death in a neonatal department from 2010 to 2017

Objective: To investigate the neonatal diseases and main causes for death in our neonatal department from 2010 to 2017. Methods: The clinical data of neonates who were admitted from January 2010 to December 2017 were retrospectively collected. The data were divided into two groups according to the year of admission (2010-2013 and 2014-2017). Incidence and mortality of major diseases were compared between the two groups. Results: A total of 25 632 neonates were included in the study. The data of the two groups (2010-2013 vs. 2014-2017) were compared. The mortality rate significantly decreased from 2.19% to 1.66% (P=0.001) and the mortality rate in neonates with GA<28 weeks (25.32% vs. 15.77%, P=0.022) and GA≥37 weeks (1.64% vs. 1.02%, P<0.001) decreased significantly. The incidences of the following complications in premature infants increased: NRDS (9.43% vs. 10.76%, P<0.001), BPD (2.05% vs 3.40%, P<0.001), ROP (1.51% vs. 2.82%, P<0.001), NEC (1.25% vs. 1.90%, P<0.001), PVL (0.77‰ vs. 2.57‰, P=0.001), and the following incidence ofbirth defects was on the rise: congenital heart disease (16.97% vs. 19.72%, P<0.001), digestive/abdominal malformation (4.19% vs. 5.13%, P=0.001). The incidence decreased in neonatal asphyxia (5.12% vs 3.33%, P<0.001), and neonatal hypoxic-ischemic brain damage (2.74% vs. 1.46%, P<0.001). On the other hand, the mortality of infection (0.89% vs. 0.21%, P<0.001), preterm NEC (30.95% vs. 17.26%, P=0.008) and sepsis (3.07% vs. 1.15%, P=0.014) decreased significantly. In addition, the mean gestational age (GA) of the test tube baby was lower than that of spontaneous pregnant baby (32.67±0.12 weeks vs. 36.99±0.02 weeks, P<0.001), with higher mortality rate (4.26% vs. 1.79%, P<0.001). Conclusion: There was a decreasing trend in the overall mortality and mortality rate for infectious diseases from 2010 to 2017. As the survival rate of premature infants was increasing, it is of vital importance to take preventive and therapeutic measures to combat the complications of premature infants. The mean GA of test tube baby was significantly lower than that of natural conception yet the mortality was much higher. With the increased incidence of birth defects, which has become one of the major causes of death, further multidisciplinary collaboration is needed to reduce the birth defect potential.