赤峰市新生儿死亡原因分析

Neonatal mortality analysis of Chifeng city

目的通过分析本市新生儿死亡情况及死因构成,为进一步降低新生儿死亡率提供依据。方法回顾性分析2018—2019年内蒙古赤峰市死亡新生儿病例资料,总结新生儿死亡率、死亡原因顺位、死亡原因分布、二级和三级医院新生儿死亡情况对比,采用t检验、χ^(2)检验进行统计分析。结果共纳入172例死亡病例,前5位死因依次为窒息(23.8%)、呼吸窘迫综合征(22.7%)、严重先天畸形(18.0%)、感染(11.6%)、早产(9.3%)。足月儿61例(35.5%),前3位死因为窒息(34.4%)、严重先天畸形(32.8%)、呼吸窘迫综合征(13.1%)。早产儿111例(64.5%),有16例(14.4%)胎龄≤30周、未经治疗即死亡,治疗后仍死亡的早产儿前3位死因为呼吸窘迫综合征(29.7%)、窒息(18.0%)、感染(15.3%)。早期新生儿124例,早期早产儿前3位死因为呼吸窘迫综合征(43.1%)、窒息(27.7%)、严重先天畸形(12.3%),早期足月儿前3位死因为窒息(44.2%)、严重先天畸形(23.3%)、呼吸窘迫综合征(18.6%)。晚期新生儿48例,晚期早产儿前3位死因为感染(33.3%)、呼吸窘迫综合征(10.0%)、严重先天畸形(10.0%),晚期足月儿前3位死因为严重先天畸形(55.6%)、窒息(11.1%)、遗传代谢/染色体病(11.1%)。与二级医院相比,三级医院死亡新生儿胎龄[(33.1±4.2)周比(35.0±5.1)周]、出生体重[(2000±480)g比(2620±515)g]均较低(P<0.05),二级医院足月儿死因中窒息比例明显高于三级医院(P<0.05)。结论新生儿死亡主要发生在生后1周内,其中窒息、呼吸窘迫综合征、严重先天畸形、感染、早产是新生儿死亡的主要原因;生后不同日龄的早产儿、足月儿死亡原因各有不同,二级医院足月儿因窒息死亡占比高于三级医院。

Objective To study the current neonatal mortality rate and causes of deaths in Chifeng city to further reduce neonatal mortality.Methods From 2018 to 2019,neonatal mortality data of Chifeng,Inner Mongolia were reviewed.Neonatal mortality,causes of deaths,the distribution of mortality in different groups of neonates and different tiers of hospitals were analyzed.Results A total of 172 neonatal deaths were included.The top five causes of deaths were asphyxia(23.8%),respiratory distress syndrome(RDS)(22.7%),severe congenital malformation(18.0%),infection(11.6%)and preterm birth(9.3%).Among the 172 neonates,61 were full-term(35.5%).The leading causes of deaths were asphyxia(34.4%),severe congenital malformation(32.8%)and RDS(13.1%).111 were premature infants(64.5%),including 16 infants(14.4%)with gestational age(GA)≤30 weeks died without treatment.The leading causes of deaths in premature infants receiving treatment were RDS(29.7%),asphyxia(18.0%)and infection(15.3%).124 cases(74.0%)were early neonatal death(END)(death within 7 d after birth).The top 3 causes of END in preterm infants were RDS(43.1%),asphyxia(27.7%)and severe congenital malformations(12.3%).The top 3 causes of END in full-term infants were asphyxia(44.2%),severe congenital malformations(23.3%)and RDS(18.6%).48 cases(26.0%)were late neonatal death(LND)(death after 7 d of age).The top 3 causes of LDN in preterm infants were infection(33.3%),RDS(10.0%)and severe congenital malformations(10.0%).The top 3 causes of LND in full-term infants were severe congenital malformations(55.6%),asphyxia(11.1%)and genetic diseases(11.1%).Compared with Tier II hospitals,the GA[(33.1±4.2)weeks vs.(35.0±5.1)weeks]and the birth weight(BW)[(2000±480)g vs.(2620±515)g]were lower in TierⅢhospitals(P<0.05).For full-term infants,the proportion of asphyxia as the cause of deaths in TierⅡhospitals was significantly higher than TierⅡhospitals(P<0.05).Conclusions Neonatal deaths mainly occur within the first week after birth with asphyxia,prematurity,severe congenital malformations,infection and RDS as the leading causes.The causes of deaths of preterm and full-term infants are different at different postnatal ages.For full-term infants,the incidences of deaths due to asphyxia are higher in TierⅡhospitals than TierⅢhospitals.