2005年至2020年单中心NICU新生儿病死率及死亡原因变化趋势分析

Analysis of trends in neonatal mortality and causes of death in NICU,2005-2020:a single-center study

目的探讨中山大学附属第一医院新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿病死率、死因别病死率(cause-specific mortality rate,CMR)及死亡原因变化。方法回顾性分析2005年至2020年该院NICU死亡病例资料,比较三个阶段(阶段Ⅰ:2005年至2009年,阶段Ⅱ:2010年至2014年,阶段Ⅲ:2015年至2020年)新生儿病死率、CMR、死亡原因情况。结果16年间NICU住院新生儿病死率为0.51%(104/20493),其中阶段Ⅰ、阶段Ⅱ、阶段Ⅲ病死率分别为0.61%(48/7855)、0.43%(27/6209)、0.45%(29/6429);与阶段Ⅰ相比较,早产儿病死率在阶段Ⅱ(3.14%vs 1.24%,χ^(2)=14.076,P<0.01)和阶段Ⅲ(3.14%vs 0.90%,χ^(2)=25.157,P<0.01)均有显著下降。81.7%(85/104)的死亡新生儿为早产儿,89.2%(91/102)的死亡新生儿存在围生期高危因素。16年间NICU死亡新生儿前三位死因依次为肺出血、出生缺陷、新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS),它们的CMR分别是1.22‰(25/20493)、0.93‰(19/20493)、0.59‰(12/20493),其他死因CMR依次是败血症0.44‰(9/20493)、早产极不成熟0.34‰(7/20493)、围生期窒息0.24‰(5/20493)。与阶段Ⅰ相比较,阶段Ⅱ(1.27‰vs 0.16‰,χ^(2)=5.487,P=0.016)和阶段Ⅲ(1.27‰vs 0.16‰,χ^(2)=5.738,P=0.014)NRDS相关病死率显著下降。阶段Ⅰ、阶段Ⅱ、阶段Ⅲ新生儿首位死亡原因分别为NRDS、肺出血和出生缺陷。71.2%(74/104)新生儿死亡发生在生后7 d内。结论16年间NICU早产儿病死率及NRDS相关病死率均显著降低,出生缺陷、感染仍是重要死亡原因,尚需进一步做好围生期保健。

Objective To investigate the changes of mortality,causes of death,and cause-specific mortality rate(CMR)of hospitalized neonates in NICU of the First Affiliated Hospital of Sun Yat-sen University.Method A retrospective study was performed to compare the mortality,cause of death,and CMR of hospitalized neonates in periodⅠ(2005-2009),periodⅡ(2010-2014)and periodⅢ(2015-2020).Result The overall mortality of hospitalized neonates in NICU of our hospital was 0.51%(104/20493)through 2005 to 2020.The mortality in periodⅠ,ⅡandⅢwere 0.61%(48/7855),0.43%(27/6209),and 0.45%(29/6429),respectively.Compared with periodⅠ,the mortality of preterm infants decreased significantly in periodⅡ(3.14%vs 1.24%,χ^(2)=14.076,P<0.01)and in periodⅢ(3.14%vs 0.90%,χ^(2)=25.157,P<0.01).Eighty-five(81.7%)neonates were premature,and ninety-one(89.2%)neonates had definite abnormal perinatal factors.The CMR of hospitalized neonates related to pulmonary hemorrhage,congenital anomalies,and NRDS were 1.22‰(25/20493),0.93‰(19/20493),and 0.59‰(12/20493),respectively.The CMR of other causes were sepsis 0.44‰(9/20493),extremely premature 0.34‰(7/20493),and perinatal asphyxia 0.24‰(5/20493),respectively.Compared with periodⅠ,specific mortality of NRDS in periodⅡ(1.27‰vs 0.16‰,χ^(2)=5.487,P=0.016)and periodⅢ(1.27‰vs 0.16‰,χ^(2)=5.738,P=0.014)significantly decreased.The leading causes of neonatal death in periodⅠ,periodⅡ,and periodⅢwere NRDS,pulmonary hemorrhage,and congenital anomalies,respectively.And 71.2%(74/104)of neonatal deaths occurred within 7 days after birth.Conclusion The mortality of preterm infants and specific mortality of NRDS in NICU have significantly decreased over the past 16 years.Congenital anomalies and infections remain important causes of death,and further efforts are needed to improve perinatal care.