480例住院新生儿的病死率及死亡原因分析

发布时间：2018-10-15 10:02

【摘要】：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。
[Abstract]:Objective to analyze the clinical characteristics and causes of death of hospitalized neonates, and to provide evidence for the study and formulation of targeted strategies to reduce neonatal mortality. Methods the clinical data of 480 newborns who died from January 2008 to December 2014 were collected, and the mortality rate of the newborns of different years, different birth ages, birth weight, different gender and different days of age were analyzed. The perinatal abnormal factors, causes of death and death grade were summarized. Results 480 of 41,910 hospitalized neonates died, The mortality rate was 1.1. The mortality of preterm infants was 1.7 and that of full-term infants was 0.7.The mortality of hospitalized neonates decreased from 1.4% in 2008 to 1.1% in 2014. The mortality of premature infants of 32 weeks of gestational age and 1 000 g of birth weight was the most obvious. The lower the gestational age, the higher the mortality of preterm and term infants. The lower the birth weight, the higher the mortality. The neonatal mortality was higher in males (1.31%vs 0.92 vs P 0.05). 61.3% of the dead neonates had definite perinatal abnormal factors, including amniotic fluid abnormality (29.4%), premature rupture of membranes (16.9%), abnormal placenta (16.9%), fetal distress (14.0%), abnormal umbilical cord (12.3%). 242 cases (50.4%) died in 37.7% of 28 days. The first three causes of death were infection, birth defect and respiratory distress syndrome. From 2008 to 2011, respiratory distress syndrome was the leading cause of neonatal death, and infection was the most important cause from 2012 to 2014. Respiratory distress syndrome (RDS) was the main cause of premature infants of 32 weeks of gestational age, weight of 1 500g newborns and death of newborns within 24 hours after birth, and infection was caused by 32 weeks of gestational age and 42 weeks of gestational age. The main causes of neonatal death at birth weight of 1 500 ~ 4 000 g and postnatal 8 ~ 28 d. Neonatal asphyxia is the main cause of death in expired infants. 54.4% of the 480 cases have inevitable death (level 1); 23.3% of them may avoid death (level 2) by creating conditions; 22.3% of them have died (third level) because of worrying about prognosis or not cooperating with treatment for reasons such as economy and so on. Conclusion the level of neonatal rescue is increasing gradually, and the mortality rate is decreasing, especially in the cases with smaller gestational age and lower birth weight. It is an important measure to reduce neonatal mortality to strengthen perinatal management, prevent neonatal infection and enhance the confidence of parents.
【作者单位】：南方医科大学陆军总医院临床医学院附属八一儿童医院;广东医科大学儿科学教研室;陆军总医院临床医学院附属八一儿童医院;
【分类号】：R722.1

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