河南省不同级别危重新生儿救治中心新生儿死亡情况分析

Analysis of neonatal deaths in critical neonatal treatment centers at different levels in Henan province

目的了解河南省不同级别危重新生儿救治中心新生儿死亡状况及死因分布。方法回顾性分析2018年1月至12月河南省18个地市共85家危重新生儿救治中心死亡病例,比较市、县级危重新生儿救治中心新生儿病死率、死亡日龄和死亡原因的异同。结果1.选取的85家医院共收治新生儿99832例,死亡318例,病死率为3.19‰。21家市级医院共收治新生儿42066例,死亡194例,病死率为4.6‰;其中早产儿109例(占56.2%)(<28周14例,28~34周70例,>34~37周25例),足月儿85例(占43.8%)。64家县级医院共收治新生儿57766例,死亡124例,病死率2.1‰;其中足月儿67例(占54.0%),早产儿57例(占46.0%)(<28周9例,28~34周34例,>34~37周14例)。市级医院新生儿病死率高于县级,差异有统计学意义(χ^2=46.589,P<0.05)。2.新生儿死亡主要发生在出生1周内,尤其在出生后1 d。21家市级医院出生1 d内死亡81例(占41.8%),其中早产儿50例(占61.7%),足月儿31例(占38.3%);64家县级医院出生1 d内死亡75例(占60.5%),其中早产儿34例(占45.3%),足月儿41例(占54.7%)。县级医院出生1 d内病死率高于市级医院,差异有统计学意义(χ^2=10.621,P<0.05)。3.导致市级与县级危重新生儿救治中心新生儿死亡的前5位原因依次为肺部疾病(130例,40.8%)、出生窒息(74例,23.3%)、感染(50例,15.7%)、先天性发育缺陷(24例,7.5%)、超早产或超低出生体质量儿(12例,4.1%)。4.早期(出生1周内)死亡的足月新生儿,市级医院的主要死因为肺部疾病(主要为新生儿呼吸窘迫综合征/急性呼吸窘迫综合征)、出生窒息、感染、先天发育缺陷;县级医院的主要死因为出生窒息、肺部疾病、感染。出生1周内死亡的早产儿,市、县级医院主要死因均为肺部疾病、出生窒息。晚期(出生2~4周)死亡的新生儿,无论是足月儿还是早产儿,市级、县级医院死亡的主要原因均为感染。结论市、县级危重新生儿救治中心在新生儿病死率、出生1 d内病死率、首位死因方面均存在差异。早期新生儿,市、县级医院主要死亡原因为肺部疾病(主要为新生儿呼吸窘迫综合征/急性呼吸窘迫综合征)、出生窒息、感染;晚期新生儿,市、县级医院死亡主要原因均为感染。有必要针对不同级别危重新生儿救治中心分门别类的进行能力提升,以降低新生儿的病死率。

Objective To investigate the death status and cause of death of newborns in critical care centers at different levels in Henan province.Methods Retrospective analysis was performed on the death cases at 85 critical neonatal treatment centers in 18 cities of Henan province from January to December 2018,and the similarities and differences in neonatal mortality,age of death and causes of death among cities and county-level critical neonatal care centers were compared.Results(1)A total of 99832 neonates were admitted to 85 hospitals,and 318 neonates died,with a mortality rate of 3.19‰.A total of 42066 neonates were admitted to 21 municipal hospitals,and 194 neonates died,with a mortality rate of 4.6‰.Among them,109 cases(56.2%)were premature infants(14 cases were of 28 weeks,70 cases were of 28-34 weeks,25 cases were of>34-37 weeks),and 85 cases(43.8%)were full-term infants.A total of 57766 neonates were admitted to 64 county-level hospitals,with 124 deaths and a mortality rate of 2.1‰.Among them,67 cases(54.0%)were full-term infants,57 cases(46.0%)were premature infants(9 cases were of 28 weeks,34 cases were of 28-34 weeks and 14 cases were of>34-37 weeks).The mortality rates at muni-cipal hospital were higher than those at the county-level hospitals,and the difference was statistically significant(χ^2=46.589,P<0.05).(2)Neonatal death mainly occurred within 1 week after birth,especially within 1 day after birth.There were 81 deaths(41.8%)in 21 municipal hospitals within 1 day,including 50 premature infants(61.7%)and 31 full-term infants(38.3%).There were 75 deaths(60.5%)in 64 county-level hospitals within 1 day,including 34 premature infants(45.3%)and 41 full-term infants(54.7%).The mortality rate in county-level hospitals was higher than that in the municipal hospital within 1 day,and the difference was statistically significant(χ^2=10.621,P<0.05).(3)The top 5 causes of neonatal death in the municipal and the county-level hospitals were pulmonary diseases(130 cases,40.8%),birth asphyxia(74 cases,23.3%),infection(50 cases,15.7%),congenital malformation(24 cases,7.5%),and very-early premature/very-low birth weight infants(12 cases,4.1%).(4)For early(within 1 week after birth)death of full-term infants,the main causes of death in municipal hospitals were lung diseases(mainly neonatal respiratory distress syndrome/acute respiratory distress syndrome),birth asphyxia,infection,congenital malformation.The leading causes of death at county-level hospitals were birth asphyxia,pulmonary diseases and infection.For premature infants who died within 1 week,the main causes of death at the municipal and the county-level hospitals were pulmonary diseases and birth asphyxia.For late-stage(2-4 weeks after birth)death of neonates,whether full-term infants or premature infants,the main cause of death in municipal and county-level hospitals was infection.Conclusions There are differences in neonatal mortality,mortality within 1 day after birth and the first cause of death at critical neonatal treatment centers at municipal and county-level hospitals.For the early-stage(within 1 week)neonates,the main causes of death in municipal and county-level hospitals are lung diseases(mainly neonatal respiratory distress syndrome/acute respiratory distress syndrome),birth asphyxia and infection.For the late-stage neonates,infection is the main cause of death in the municipal and the county-level hospitals.It is necessary to improve the neonatal care ability of critical neonatal treatment centers at different levels separately in order to reduce neonatal mortality.