5省部分医院新生儿死前救治及死亡原因调查

A survey of treatment and resuscitation of newborns prior to death and cause of death in some hospitals in five provinces of China

目的 了解新生儿死前在产科或儿科救治的情况及其死亡的直接原因,为采取针对性措施、提高产科和儿科的救治水平提供依据.方法 收集2008年5～12月间我国5个省部分医院的108例新生儿死亡调查表.调查表为自行设计,在新生儿死后7天内由所在医院参与救治人员填写完成.采用现场询问和查阅病历的方法 ,对其中26例可避免死亡病例的死前救治情况进行调查,并对所获得的定性资料进行归纳总结,对新生儿死亡发生情况进行描述性统计分析.结果 出生窒息、早产及低出生体重、肺炎和败血症是医院新生儿死亡的前4位死因.死于出生窒息的新生儿中,生后1分钟和5分钟时重度窒息分别占48.5%和54.6%;死于早产及低出生体重的新生儿中,51.9%的出生体重在1 500g以下;90.7%的新生儿死亡发生在生后7天内,出生窒息为第1位死因,9.3%发生在7天后,感染为第1位死因.对26份病例的定性调查显示,新生儿死前救治措施不适宜,主要表现在对产程异常的用药不规范、处理不及时、早产儿未能及时转诊、新生儿治疗不规范、未按标准程序进行新生儿复苏及产科和儿科缺乏沟通与合作等方面.结论 出生窒息是医院内新生儿首位死因.亟待建立和健全产科和儿科对新生儿救治的常规及监督其执行的机制.

Objective To investigate treatment and resuscitation processes of newborns prior to death in departments of neonatology and obstetrics and their causes of death, so as to provide evidences and corresponding measures to improve treatment and resuscitation success rate for the newborns. Methods 108 neonatal mortality questionnaire forms from some hospitals in 5 provinces in a period from May to December of 2008 were retrospectively surveyed. The questionnaire was designed by researchers themselves and was filled by the treating doctors within 7 days after neonate＇ s death. In spot inquire and case-note review methods, the treatment and resuscitation processes of 26 avoidable deaths were audited. The qualitative data obtained were summarized and descriptive statistics （proportions, means, and medians） were used to analyse factors associated with death of infants. Results Asphyxia at birth, premature labor and low birth weight, neonatal pneumonia and septicemia were first 4 causes of neonatal deaths in these hospitals. The proportions of serious asphyxia occured at the first and the fifth minute after birth were 48.5% and 54.6% respectively in those newborns died of asphyxia. The proportion of dead neonates whose birth weight was under 1500g was 51.9% in those newborns died of premature labor and low birth weight. 90. 7% of newbems died before 7 days after birth and the first cause of neonatal death was asphyxia. 9.3% of newborns died beyond 7 days after birth and the first cause of neonatal death was infections. The qualitative investigation on clinical data of 26 dead neonates showed that treatment and resuscitation methods of neonates prior to death were incorrect , such as incorrectly using medicines and delaying treatment for abnormal labor processes, not referring premature babies timely, not following treatment guidelines, not following the standard procedures for resuscitation and being lack of communication between departments of obstetrics and neonatology. Conclusion Asphyxia at birth is the most common cause of death of neonate. Standards of treatment and resuscitation for the newborns in departments of obstetrics and neonatology and surveillance system for treatment and resuscitation need to be established and improved.