不同胎龄层住院新生儿疾病谱及死亡分析

Analysis of disease spectrum and mortality rate of all hospitalized neonates by gestational age

目的分析邯郸市中心医院2018年住院新生儿的疾病谱、病死率及死亡独立危险因素,作为临床救治规范化及质量改进的基线水平。方法收集邯郸市中心医院2018年1月至12月期间住院的1842例新生儿的临床资料,分析住院新生儿疾病构成及围产期相关因素,并进行死亡原因及独立危险因素分析。统计学方法采用χ^(2)和符号秩和检验。结果①男女性别比为1.32∶1;早产儿占住院新生儿的44.8%(825/1842)。②64.8%(1194/1842)的住院新生儿母亲患有妊娠合并症,随着胎龄的增加,住院新生儿的母亲患有妊娠合并症、胎膜早破、妊娠期高血压、子痫前期的发生率有所下降(P<0.01),合并羊水污染的发生率有所上升(P<0.01)。③住院新生儿中9.1%(168/1842)合并出生缺陷。④住院新生儿前5位病种依次为:肺炎、高胆红素血症、颅内出血、败血症、呼吸窘迫综合征;住院早产儿的主要疾病为肺炎、呼吸窘迫综合征、窒息、颅内出血及低血糖,且发生率高于足月儿(P<0.01);高胆红素血症、化脓性脑膜炎多发生于足月儿(P<0.05)。⑤住院新生儿病死率为2.9%(54/1842),超早产儿及极早产儿(<32周)为住院新生儿死亡的主要人群,占死亡患儿的50.0%(27/54)。⑥出生缺陷、胎龄小、出生体重低是导致住院新生儿死亡的独立危险因素。结论肺炎、高胆红素血症、败血症、窒息、呼吸窘迫综合征是新生儿住院的主要原因,<32周的早产儿为住院新生儿死亡的主要人群。基于全住院新生儿的主要疾病的患病率和病死率提示地区性三级围产-新生儿中心的救治质量的基本特征,为进一步改进对极早产儿及高危新生儿的救治质量提供了比较依据。

Objective To analyze all hospitalized neonatal patients in Handan Central Hospital in 2018,including their spectrum of diseases,perinatal exposure as risks,and cause of death,to standardize and improve clinical treatment.Methods The clinical data of 1842 hospitalized neonates were collected in Handan Central Hospital from January to December in 2018.The spectrum of diseases,perinatal exposure and cause of death were analyzed by independent risk factors.Statistical methods performed byχ^(2) and signed rank sum test.Results①Of all hospitalized neonates,there were maleto-female ratio of 1.32∶1;preterm infants accounted for 44.8%(825/1842).②64.8%(1194/1842)mothers encountered significant pregnancy complications;with increasing gestational age,there was a trend of lower prevalence of pregnancy complications,premature rupture of membranes,hypertension of pregnancy,preeclampsia/eclampsia showed downtrend(P<0.01),but prevalence of amniotic fluid contamination was increased(P<0.01).③The incidence of birth defects was 9.1%(168/1842).④The top five diseases of the hospitalized neonates were pneumonia,hyperbilirubinemia,intracranial hemorrhage,sepsis and respiratory disease syndrome.The incidence of pneumonia,respiratory disease syndrome,asphyxia,intracranial hemorrhage and hypoglycemia in premature infants was higher than in the term infants(P<0.01),but the incidence of hyperbilirubinemia and purulent meningitis in preterm infants was lower than in the term infants(P<0.05).⑤There were 2.9%(54/1842)of the hospitalized neonates death rate,very preterm infants(<32 weeks gestation)were the main group of the deaths of the neonatal infants,accounted for 50.0%(27/54).⑥Birth defects,small for gestational age,low birth weight were independent risk factors for the deaths of the infants.Conclusions The Hospitalized newborn infants diseases were predominantly composed of Pneumonia,jaundice,sepsis,asphyxia,respiratory distress syndrome(RDS).Very preterm infants(<32 weeks gestation)were the main group of the deaths of the neonatal infants.These results suggest that by analyzing prevalence and mortality rate of all hospitalized neonatal patients,it may be served as a baseline for characteristics of a tertiary perinatal-neonatal center of a region for quality improvement in the care of very preterm and critically ill neonatal infants.