1999～2008年上海市早期新生儿死亡原因分析

Analysis on the causes of early neonatal death in Shanghai from 1999 to 2008

目的:探讨1999～2008年上海市早期新生儿死亡原因及存在主要问题,为进一步降低围产儿死亡率提供参考。方法:回顾性分析1999～2008年上海市产科工作情况报表及上海市围产儿死亡、出生缺陷登记表的相关资料。结果:①1999～2008年上海市共死亡早期新生儿2336例,死亡率为2.00‰,其中本市户籍死亡率1.27‰、非本市户籍死亡率2.86‰。②本市户籍第一位死因为严重畸形占26.56%,其后依次为早产、产时窒息、宫内窘迫及肺透明膜病;非本市户籍第一位死因为早产占19.75%,其后依次为严重畸形、产时窒息、肺透明膜病及宫内窘迫。③本市户籍早期新生儿前后5年死因顺位的主要变化为"产时窒息"明显下降,后5年的死亡构成较前5年下降53.61%,而死亡专率下降77.78%。非本市户籍的死因顺位主要变化为"宫内窘迫"由第5位上升到第4位,死亡构成较前5年上升6.52%,死亡专率下降44.00%。结论:加强对外来流动人口的围产期保健管理,并针对产前诊断、早产管理、新生儿窒息复苏等采取有效措施,降低早期新生儿死亡率、提高围产保健质量。

Objective：To explore the causes of early neonatal death in Shanghai from 1999 to 2008 and find out main problems, so as to provide a basis for further reducing perinatal mortality rate （PMR） in Shanghai.Methods：Obstetric working reports, related data of death and birth defects registration forms in Shanghai from 1999 to 2008 were analyzed retrospectively.Results：The mortality rate of early neonates in Shanghai from 1999 to 2008 was 2.00‰ （2 336 neonates）, the mortality rates of local neonates and floating neonates were 1.27‰ and 2.86‰, respectively. The first death cause of local neonates was severe malformation, accounting for 26.56%, followed by premature delivery, neonatal asphyxia, intrauterine distress and hyaline membrane disease; the first death cause of floating neonates was premature delivery, accounting for 19.75%, followed by severe malformation, neonatal asphyxia, hyaline membrane disease and intrauterine distress. The changes of rank order of death causes of early neonates from 1999 to 2008 included that the incidence of neonatal asphyxia decreased significantly, the proportion of neonatal death in the last five years reduced by 53.61% compared with that in the first five years, the specific death rate reduced by 44.00%.Conclusion：The methods including enhancing perinatal health management of floating population, taking effective measures targeted to prenatal diagnosis, premature delivery and recovery of neonatal asphyxia should be provided to reduce mortality rate of early neonates and increase the quality of perinatal health.