480例住院新生儿的病死率及死亡原因分析

目的分析住院新生儿病死率以及死亡新生儿的临床特点及死亡原因,为研究及制定降低新生儿病死率的针对性策略提供依据。方法收集2008年1月至2014年12月期间480例死亡新生儿的临床资料,分析不同年份、不同出生胎龄、出生体重、不同性别、不同日龄新生儿的病死率,并进行死亡新生儿围产期异常因素、死亡原因及死亡等级总结。结果 41 910例住院新生儿中死亡480例,病死率为1.1%,其中早产儿病死率1.7%、足月儿病死率0.7%;住院新生儿病死率从2008年的1.4%降至2014年的1.1%,以出生胎龄32周的早产儿和出生体重1 000 g新生儿的病死率下降最为明显。早产儿和足月儿中出生胎龄越小病死率越高,过期产儿的病死率又有升高。出生体重越低,病死率越高。新生儿病死率以男性较高(1.31%vs 0.92%,P0.05)。死亡新生儿中有明确围产期异常因素的占61.3%,包括羊水异常(29.4%),胎膜早破(16.9%),胎盘异常(16.9%),胎儿宫内窘迫(14.0%),脐带异常(12.3%)等。480例死亡新生儿中生后24 h内死亡者57例,占11.9%;2~7 d死亡者181例,占37.7%;8~28 d死亡者242例,占50.4%。前3位死亡原因为:感染、出生缺陷、呼吸窘迫综合征。2008~2011年以呼吸窘迫综合征为新生儿死亡的最主要原因,2012~2014年以感染为最主要的原因。呼吸窘迫综合征是出生胎龄32周早产儿、出生体重1 500 g新生儿及生后24 h内死亡新生儿的最主要原因;感染是出生胎龄32~42周、出生体重1 500~4 000 g及生后8~28 d新生儿死亡的最主要原因。新生儿窒息是过期产儿主要死亡原因。480例中不可避免死亡(一级)的占54.4%;创造条件可能避免死亡(二级)占23.3%;因担心预后或因经济等原因不配合治疗死亡(三级)的占22.3%。结论新生儿救治水平逐步提高,病死率有下降趋势,尤其是胎龄较小及出生体重较低新生儿的病死率下降更明显。加强围产期管理,预防新生儿感染等疾病,增强患儿家长救治信心,是降低新生儿死亡率的重要措施。

Mortality rate and cause of death in hospitalized neonates: an analysis of 480 cases

ObjectiveTo investigate the mortality rate and the cause of death of hospitalized neonates.Methods The clinical data of 480 neonates who died between January 2008 and December 2014 were collected. The mortality rates of neonates with different gestational ages, birth weights, sexes, and ages in days were analyzed. The abnormal perinatal factors, cause of death, and death grade were summarized.ResultsAmong the 41 910 hospitalized neonates, 480 (1.1%) died, and the mortality rates of preterm infants and full-term infants were 1.7% and 0.7%, respectively. The mortality rate of hospitalized neonates decreased from 1.4% in 2008 to 1.1% in 2014, and the decrease was more apparent in the preterm infants with a gestational age of <32 weeks and the neonates with a birth weight of <1 000 g. Among preterm infants and full-term infants, those with a lower gestational age tended to have a higher mortality rate, but post-term infants had an increased mortality rate. The infants with a lower birth weight tended to have a higher mortality rate. Male neonates had a signiifcantly higher mortality rate than female neonates (1.31% vs 0.92%;P<0.05).Among the neonates who died, 61.3% had definite abnormal perinatal factors, including abnormal amniotic fluid (29.4%), premature rupture of membranes (16.9%), placental abnormality (16.9%), fetal intrauterine distress (14.0%), and abnormal umbilical cord (12.3%). Among the 480 neonates who died, 57 (11.9%) died within 24 hours after birth, 181 (37.7%) died within 2-7 days, and 242 (50.4%) died within 8-28 days. The three most common causes of death were infection, birth defect, and respiratory distress syndrome. The most common cause of death was respiratory distress syndrome in 2008-2011 and infection in 2012-2014. Respiratory distress syndrome was the most common cause of death in preterm infants with a gestational age of <32 weeks, neonates with a birth weight of <1 500 g, and neonates who died with 24 hours; infection was the most common cause of death in neonates with a gestational age of 32-42 weeks, neonates with a birth weight of 1 500-4 000 g, and neonates who died within 8-28 days. Neonatal asphyxia was the major cause of death in post-term infants. Inevitable deaths (grade 1) accounted for 54.4%, deaths that could be avoided under certain conditions (grade 2) accounted for 23.3%, and deaths caused by concerns about prognosis or economic reasons (grade 3) accounted for 22.3%.ConclusionsIn recent years, the treatment of neonates has gradually improved, and the mortality rate of neonates is gradually decreasing, especially in neonates with low gestational age and birth weight. Important measures for reducing the mortality rate in neonates include enhancing perinatal management, reducing abnormal perinatal factors, preventing infection, and increasing parents’ conifdence in treatment.