1998-2017年住院新生儿死亡原因分析

Analysis on Newborns Cause of Death from 1998 to 2017

目的:了解1998-2017年20年内住院新生儿死亡原因及逐年死亡率变化情况。方法:对20年内收治的14967例住院新生儿中178例死亡新生儿进行回顾性分析,对比前后10年(1998-2007年为前10年,2008-2017年为后10年)死亡新生儿的胎龄、出生体质量、性别、日龄、死亡诊断、母亲年龄、分娩方式等病例资料,分析死亡新生儿的死亡率、死亡原因及相关因素。结果:20年住院新生儿死亡率1.19%,后10年住院新生儿死亡率(0.79%)较前10年死亡率(2.73%)显著下降,男婴死亡率高于女婴,体质量越低、出生日龄越小、死亡率及死亡构成比也越高,差异有统计学意义(P<0.001);新生儿死亡病因前5位依次为新生儿窒息(33.71%)、呼吸窘迫综合征(RDS)(24.16%)、感染(22.47%)、肺出血(11.11%)及先天畸形(4.49%);早期新生儿死亡的主要因素包括羊水异常(18.03%)、多胎早产(14.75%)、胎膜早破(13.66%)、脐带异常(11.48%)、宫内窘迫(11.48%)、妊高症及子痫(6.56%)等,其他因素包括母亲高龄初产妇、母亲晚期感染、疤痕子宫、未建卡、未定期产检及选择分娩方式等。结论:近20年住院新生儿死亡率整体呈下降趋势,死亡原因以新生儿窒息、RDS、感染、肺出血及先天畸形为主。

Objective:To investigate the reasons and yearly mortality rate changes for hospitalized neonates from 1998 to 2017.Methods:Retrospective analysis of 178 neonatal death cases out of 14,976 registered neonates over 20-year time,comparing following data between the first 10 years and the second 10 years(1998 to 2007 and 2008 to 2017)to analyze mortality rate,cause of death and relevant factors:gestational age,birth weight,gender,days,death diagnosis,maternal age,method of delivery.Results:The neonates mortality rate of 20 years was 1.19%,and the neonatal mortality rate in the second 10 years(0.79%)was significantly lower than the first 10 years mortality rate(2.73%).The male infant mortality rate was higher than that of the female infant;the lower the birth weight,the younger the age,the higher the mortality rate and proportion of dying,difference was statistically sig nificant(P<0.001).Top five causes of neonatal death are neonatal asphyxia(33.71%),Respiratory Distress Syndrome(RDS)(24.16%),infection(22.47%),pneumorrhagia(11.11%)and congenital malformation(4.49%);causes of death in early newborn are abnormal amniotic fluid(18.03%),multiple birth premature delivery(14.75%),premature rupture of membrane(13.66%),abnormality of umbilical cord(11.48%),IUGR(11.48%),pregnancy induced hypertension and eclamptism(6.56%).Other causes including elderly primipara,maternal advanced stage,scar uterus,no hospitalized record,irregular antepartum check and method of delivery.Conclusion:The overall mortality rate of hospitalized neonates was decreasing.The cause of death is common with asphyxia,followed by RDS,infection,pulmonary hemorrhage and congenital malformation.