2006-2015年住院新生儿病因及死亡变化趋势分析

Analysis on causes and change trend of neonatal death in hospital from 2006 to 2015

目的分析2006-2015年温州市人民医院住院新生儿病因及死亡变化趋势,为新生儿疾病防控提供指导。方法回顾性分析2006-2015年温州市人民医院住院及死亡新生儿病例资料,分为2006-2010年、2011-2015年2个时间段,统计新生儿时期常见病类型,分析死亡趋势变化及死因构成变化。结果 12006-2010年新生儿病因以新生儿高胆红素血症(黄疸)(31.78%)、新生儿窒息(23.38%)、新生儿肺透明膜病(14.68%)为主要病因;2011-2015年病因以黄疸(38.91%)、新生儿肺炎(16.31%)、新生儿窒息(13.02%)为主要病因;黄疸仍为主要病因,新生儿窒息、新生儿肺透明膜病均有减少,前后5年新生儿窒息及新生儿肺透明膜病在疾病构成所占比例对比差异有统计学意义(P<0.05)。210年间该院新生儿死亡率为1.20%。死亡新生儿以男性多见,出生≤7 d死亡率高于出生>7 d,流动人口死亡率高于常住人口,早产儿死亡率高于足月新生儿(P<0.05)。32010年新生儿死亡率最高,其次为2006年,2007年位列第3;2006年后新生儿死亡率缓慢下降,2009年有所上升,2010年后逐渐下降,随后2年下降趋势明显。42006-2010年新生儿肺透明膜病为新生儿主要死因,其次为早产儿、新生儿肺炎、新生儿窒息;2011-2015年早产儿病死率有所下降,但仍为主要病因,其次为新生儿肺透明膜病、新生儿肺炎、新生儿窒息。2011-2015年新生儿肺炎、早产儿死亡率对比差异有统计学意义(P<0.05)。结论 2006-2015年,该院新生儿住院病因以黄疸、新生儿肺炎、新生儿肺透明膜病为主,10年间住院新生儿死亡率逐渐下降,后5年下降明显,早产儿、男性、流动人口死亡率较高,早产、新生儿肺透明膜病、新生儿肺炎、新生儿窒息为其主要死因。为降低新生儿死亡率,必须强化产前筛查,加强孕期宣教,引进新生儿复苏技术。

Objective To analyze the causes and change trend of neonatal death in hospital from 2006 to 2015 in Wenzhou city,provide guidance for prevention and control of neonatal diseases. Methods The clinical data of hospitalized and dead neonates in the hospital was analyzed retrospectively. Then the data was divided into two time periods： 2006- 2010 and 2011- 2015. The types of neonatal common diseases,change trend of causes of neonatal death,and changes of death constitution were analyzed statistically. Results From 2006 to2010,the main causes of neonatal diseases were neonatal hyperbilirubinemia（ 31. 78%）,neonatal asphyxia（ 23. 38%）,and neonatal hyaline membrane disease（ 14. 68%）; from 2011 to 2015,the main causes of neonatal diseases were jaundice（ 38. 91%）,neonatal pneumonia（ 16. 31%）,and neonatal asphyxia（ 13. 02%）. Jaundice was the main cause. The incidence rates of neonatal asphyxia and neonatal hyaline membrane disease decreased. There were statistically significant difference in proportions of neonatal asphyxia and neonatal hyaline membrane disease between the former five years and the latter five years（ P〈0. 05）. In 10 years,neonatal mortality rate in the hospital was1. 20%. The dead neonates were mainly male,the mortality rate of neonates born ≤7 days was higher than that of neonates born 7 days.The mortality rate of floating population was higher than that of resident population,and the mortality rate of premature neonates was higher than that of full- term neonates（ P〈0. 05）. The mortality rate of neonates in 2010 was the highest,followed by 2006 and 2007. After2006,neonatal mortality rate decreased slowly and increased in 2009,then it decreased after 2010. The mortality rate decreased significantly in the following 2 years. From 2006 to 2010,neonatal hyaline membrane disease was the main cause of neonatal death,followed by premature birth,neonatal pneumonia,and neonatal asphyxia; from 2011 to 2015,the mortality rate of premature infants decreased,but it was still the main cause of neonatal death,followed by neonatal hyaline membrane disease,neonatal pneumonia,and neonatal asphyxia. There were statistically significant differences between the mortality rates caused by neonatal pneumonia and premature birth from 2011 to 2015（ P〈0. 05）. Conclusion From 2006 to 2015,the main causes of neonatal death includes jaundice,neonatal pneumonia,and neonatal hyaline membrane disease. In 10 years,the mortality rates of neonates decreased gradually and decreased significantly in later 5 years. The mortality rates of premature neonates,male neonates,and floating population were relatively higher. Premature delivery,neonatal hyaline membrane disease,neonatal asphyxia and neonatal pneumonia are the main causes of neonatal death. In order to reduce the neonatal mortality rate,prenatal screening and education must be strengthened and neonatal resuscitation technique should be introduced.