2014-2019年银川市13476例重症监护新生儿临床特点及流行病学调查

Epidemiological survey and clinical characteristics of 13476 neonates in intensive care in Yinchuan city from 2014 to 2019

目的探讨银川市妇幼保健院新生儿重症监护室(neonatal intensive care unit,NICU)内新生儿临床特点及流行病学调查,为临床疾病治疗及预防提供指导。方法回顾性分析2014—2019年入住银川市妇幼保健院NICU的新生儿临床资料,并按2014—2015年、2016—2017年及2018—2019年分为3个时间段,应用SPSS 22.0数据统计软件对新生儿的基本资料、临床结局及原发疾病病种的性别、民族、季节分布进行统计分析。结果2014—2019年入住NICU的新生儿共13476例,平均胎龄(33.66±5.44)周,平均出生体质量(3059±785)g,入院中位日龄为0.49 d,平均住院天数为(6.99±0.06)d,低出生体质量儿与巨大儿的构成比呈现下降趋势(χ^(2)=38.09,P<0.05);治愈或好转出院的新生儿12430例(92.3%),自动出院1024例(7.6%),死亡13例(0.09%),新生儿的治愈/好转率逐年提高,死亡率及自动出院率逐年下降,差异有统计学意义(χ^(2)=16.12,P<0.05)。原发疾病中排名前3位病种依次为新生儿黄疸5079例(37.71%)、新生儿肺炎2359例(17.51%)及早产儿1326例(9.85%),前3位病种约占入院总人数的65.07%,其中新生儿黄疸及早产儿的构成比呈现下降趋势(χ^(2)=78.20,P<0.01;χ^(2)=77.79,P<0.01),而新生儿肺炎的构成比明显上升(χ^(2)=402.3,P<0.01)。男婴发病率高于女婴的疾病分别为:新生儿肺炎(χ^(2)=4.95,P=0.026)、新生儿窒息(χ^(2)=6.74,P=0.009)。女婴发病率高于男婴的疾病分别为:新生儿ABO溶血病(χ^(2)=22.11,P=0.000)、新生儿低血糖症(χ^(2)=18.65,P=0.000)。回族新生儿黄疸的构成比要高于汉族儿童(χ^(2)=12.37,P=0.000),早产儿构成比低于汉族儿童(χ^(2)=4.04,P=0.04)。新生儿黄疸在秋、冬季的发生比例低于夏季(χ^(2)=8.82,P=0.003;χ^(2)=4.24,P=0.039);新生儿ABO溶血病在秋、冬季的发病率高于夏季(χ^(2)=4.55,P=0.033;χ^(2)=23.60,P=0.000);新生儿脓疱疹在夏季的发生比例高于冬季(χ^(2)=0.16,P=0.001),急性呼吸窘迫综合征在秋季的发生比例高于春季(χ^(2)=18.34,P=0.000)、夏季(χ^(2)=5.14,P=0.023)及冬季(χ^(2)=10.07,P=0.002)。结论在银川市妇幼保健院NICU住院新生儿疾病以新生儿黄疸、新生儿肺炎及早产儿为主,新生儿黄疸及早产儿的构成比呈现下降趋势,新生儿肺炎呈上升趋势;低出生体质量儿及巨大儿的发生率逐年下降;性别、民族及季节可影响原发疾病的分布,所以临床工作中应该针对性地加强相关疾病的诊治管理以及围生期的保健宣教工作。

Objective To explore the clinical characteristics and epidemiological investigation of neonates in the neonatal intensive care unit in Yinchuan Women and Children Health Care Hospital,and to provide guidance for the treatment and prevention of clinical disea⁃ses.Methods Retrospective analyze the clinical data of neonates admitted to the NICU in 2014—2019,and divide them into 3 time periods according to 2014—2015,2016—2017 and 2018—2019,and apply SPSS 22.0 data statistics software to the basics of neonates Statistical analysis of data,clinical outcomes,and gender,ethnicity,and seasonal distribution of primary disease types.Results A total of 13476 neonates were admitted to NICU from 2014 to 2019,with an average gestational age of(33.66±5.44)weeks,an average birth weight of(3059±785)g,a median age of admission of 0.49 d,and an average length of hospitalization of(6.99±0.06)d,the proportion of low birth weight infants and giant infants showed a downward trend(χ^(2)=38.09,P<0.05);12430 cases(92.3%)of newborns who were cured or improved were discharged,and 1024 cases(7.6%)were discharged automatically There were 13 deaths(0.09%),the rate of cure/improvement of newborns increased year by year,and the mortality and automatic discharge rate decreased year by year,with statistical differences(χ^(2)=16.12,P<0.05).The top three diseases in the order of primary diseases were 5079 cases of neonatal jaundice(37.71%),2359 cases of neonatal pneumonia(17.51%),1326 cases of premature babies(9.85%),and the top 3 diseases accounted for about 65.07%of the population,of which the proportion of neonatal jaundice and premature babies showed a downward trend(χ^(2)=78.20,P<0.01;χ^(2)=77.79,P<0.01),while the proportion of neonatal pneumonia increased significantly(χ^(2)=402.3,P<0.01).The diseases of male boys with higher incidence than female girls are:neonatal pneumonia(χ^(2)=4.95,P=0.026),neonatal asphyxia(χ^(2)=6.74,P=0.009).Diseases with a higher incidence of female infants than male infants are:neonatal ABO hemolytic disease(χ^(2)=22.11,P=0.000),neonatal hypoglycemia(χ^(2)=18.65,P=0.000).The proportion of neonatal jaundice in Hui is higher than that of Han chil⁃dren(χ^(2)=12.37,P=0.000),and the proportion of premature infants is lower than that of Han children(χ^(2)=4.04,P=0.04).The inci⁃dence of neonatal jaundice in autumn and winter is lower than that in summer(χ^(2)=8.82,P=0.003;χ^(2)=4.24,P=0.039);the incidence of neonatal ABO hemolytic disease in autumn and winter is higher than that in summer(χ^(2)=4.55,P=0.033;χ^(2)=23.60,P=0.000);the incidence of neonatal pustular herpes in summer is higher than that in winter(χ^(2)=0.16,P=0.001),and the incidence of acute respiratory distress syndrome in autumn is higher than that in spring(χ^(2)=18.34,P=0.000),summer(χ^(2)=5.14,P=0.023)and winter(χ^(2)=10.07,P=0.002).Conclusion The neonatal diseases hospitalized in NICU in Yinchuan Women and Children Health Care Hospital are mainly neonatal jaundice,neonatal pneumonia and premature infants.The proportion of neonatal jaundice and preterm infants shows a down⁃ward trend,and neonatal pneumonia shows an upward trend;the occurrence of low birth weight infants and huge infants The rate decreases year by year;gender,ethnicity,and season can affect the distribution of primary diseases,so the clinical work should be targeted to strengthen the diagnosis and treatment of related diseases and perinatal health care and education.