中山市2003-2012年新生儿死亡分析及干预对策

Analysis of the causes and intervention strategy of neonatal death in Zhongshan city from 2003 to 2012

目的分析2003-2012年中山市新生儿死亡情况,为进一步降低新生儿死亡率制定干预措施提供参考依据。方法回顾分析2003-2012年中山市产科质量情况报表及新生儿死亡登记的相关资料。结果 1)2003-2012年中山市活产数为453 925例,新生儿死亡1 463例,死亡率为3.22‰,其中早期新生儿死亡669例,死亡率为1.47‰;早期新生儿死亡占新生儿死亡率的45.73%;2)前三位死因依次:窒息295例(20.16%)、早产低出生体重293例(20%)、先天异常194例(13.26%),其中先天性心脏病88例(6.02%);3)中山市近十年早产发生率为4.10%;窒息发生率为1.77%。前后5年对比:中山市新生儿死亡率由4.04‰下降到2.41‰;早产发生率由3.66%上升到4.34%,早产死亡率由0.77‰下降到0.50‰;出生窒息率由2.34%下降到1.42%,窒息死亡率由0.91‰下降到0.42‰;出生缺陷死亡率由0.56‰下降到0.30‰;4)对2007-2011年中山市围产儿死亡中43例(12.13%)足月儿"产时重度窒息"个案评审,其中羊水污染者34例(62.79%)。结论建立以卫生行政部门为主导,妇幼保健系统、医疗管理部门、临床科室紧密配合的机制,完善产前、产时母婴监护措施,加强对基层围产工作者技能的培训,重点控制早期新生儿死亡,可有效降低新生儿死亡率。

Objective To explore the causes of neonatal death in Zhongshan city from 2003 to 2012,and to provide a basis for further reducing neonatal mortality rate in Zhongshan city. Method Relevant data of death form obstetrics quali- ty report and neonatal death registration in Zhongshan city from 2003 to 2012 were analyzed retrospectively. Results 1） A total of 1 463 neonates died from 2003 to 2012 in Zhongshan City,mortality was 3.22‰ ,the early neonatal death was 669 cases,mortality was 1.47%; Early neonatal death was 45.73% of neonatal death. 2）The top three death causes were： as- phyxia in 295 cases（20. 16%）, premature and low birth weight in 293 cases （20%）,congenital abnormality in 194 cases （13.26%） ,including congenital heart disease in 88 cases （6.02%）. 3）The incidence of premature was 4. 10% and of as- phyxia was 1.77% in recent ten years of Zhongshan city. Compared before and after 5 years： the neonatal mortality rate in Zhongshan City dropped from 4.04%o to 2.41‰; The incidence of premature increased from 3.66 % to 4.34 %, premature mortality declined from 0.77‰ to 0.50‰; Birth asphyxia rate dropped from 2. a4M to 1.42% ,asphyxia mortality dropped from 0.91‰ to 0.42‰; Birth defect mortality dropped from 0.56‰ to 0.30‰. 4） The 43 infants （12. 13%） with ＂severe asphyxia＂ in perinatal deaths of Zhongshan city from 2007 to 2011 were case reviewed,including 34 cases with anmiotic fluid pollution （62.79%）. Conclusions To establish the health administrative departments as the leading mechanism,maternal and child health care system, medical management, clinical departments should cooperate closely to improve prenatal, intrap artum maternal and child care measures,strengthen the local perinatal workers skills training, focus on the control of early neonatal death, which can effectively reduce the neonatal mortality.