儿童医院住院早期新生儿134例死亡原因分析

Analysis on causes of 134 early neonatal death in children's hospital

目的:回顾性总结并分析上海市儿童医院住院早期新生儿死亡病例的主要死因。方法:调查上海市儿童医院1997年1月～2009年12月死亡住院新生儿的病历资料,分析住院早期新生儿死亡病例的临床情况及其主要死因。结果:1997年1月～2009年12月共收治住院新生儿18 061例,其中死亡201例。医治无效死亡的生后1周内早期新生儿134例,其中早产儿59例,足月儿75例,占新生儿死亡66.67%,多数在出生后3天内死亡,在生后<24 h、24～72 h、4～7天,早产儿和足月儿死亡分别为27例(45.76%)、18例(30.51%)、14例(23.73%);35例(46.67%)、16例(21.33%)、24例(32.00%)。早期新生儿主要死因前三位:早产儿为呼吸窘迫综合征、极低或超低出生体重儿并发肺炎和重度围产期窒息,足月儿为先天畸形、重度围产期窒息和败血症。结论:为降低住院新生儿的病死率,新生儿科医生应尽早识别出危重新生儿,按各种疾病的高度危险期积极救治,并提高早产儿的监护和治疗水平。

Objective：To summarize and analyze the main causes of early neonatal death in Shanghai children’s hospital.Methods：The medical records of early neonatal death in the hospital from January 1997 to December 2009 were investigated,the clinical conditions and the main causes of the early neonatal death were analyzed.Results：18 061 neonates hospitalized in the hospital from January 1997 to December 2009,and 201 of them died.The proportion of early neonatal death within one week after birth was 66.67%（134 cases）,including 59 premature infants and 75 mature infants,most of the neonates died within 3 days after birth;the mortalities of premature infants within 24 hours,24～72 hours and 4～7 days after birth were 45.76%（27 cases）,30.51%（18 cases）,23.73%（14 cases）,respectively;and the mortalities of mature infants within 24 hours,24～72 hours and 4～7 days after birth were 46.67%（35 cases）,21.33%（16 cases）,32.00%（24 cases）,respectively.The first three main causes of early neonatal death：premature infants（respiratory distress syndrome,extremely low or very low birth weight infants,pneumonia and severe perinatal asphyxia）,mature infants（congenital malformation,severe perinatal asphyxia,sepsis）.Conclusion：In order to reduce the mortality of hospitalized neonates,the neonatal physicians should recognize critically ill neonates early,take an active therapy during the critical stage of every disease,and improve the levels of intensive care and treatment for premature neonates.