2017~2021年某市新生儿死亡评审分析

Analysis of neonatal death reviews in a city from 2017 to 2021

目的探究某市2017~2021年新生儿死亡现状及其发生因素,总结新生儿死亡评审工作经验,合理制定干预对策,以降低新生儿死亡率。方法收集某市2017~2021年新生儿死亡相关数据,对新生儿死亡相关评审资料开展分析。结果2017~2021年全市出生活产新生儿413018例,新生儿死亡491例,新生儿死亡率总体呈下降趋势,死亡率由2017年1.46‰下降到2021年的0.89‰,下降幅度为0.57‰。2017~2021年,在婴儿死亡中,新生儿死亡占比分别为65.52%、63.29%、51.28%、63.57%、53.21%,而在<5岁儿童中,新生儿死亡占比分别为54.51%、48.88%、34.19%、45.88%、33.14%。5年合计男童新生儿死亡率(1.29‰)高于女童(1.07‰),差异具有统计学意义(P<0.05)。新生儿死亡原因主要集中在早产或低出生体重、出生窒息、先天性心脏病、其他先天异常、其他新生儿病、败血症,其中早产或低出生体重每年均为死因顺位第一。新生儿出生胎龄越小,死亡率越高,比较差异具有统计学意义(P<0.05)。出生体重越低,死亡率越高,不同出生体重新生儿死亡率比较差异具有统计学意义(P<0.05);巨大儿的新生儿死亡率稍低于正常出生体重儿,差异无统计学意义(χ^(2)=1.054,P=0.305>0.05)。2017~2021年市级选取典型、疑难、共性死亡病例进行新生儿死亡评审共52例,评审结论为可避免死亡7例,占13.46%,创造条件可避免死亡29例,占55.77%,不可避免死亡16例,占30.77%。结论应加强孕产期保健宣教及高危妊娠管理,提高助产技术,持续推进新生儿科建设,加强医护人员对新生儿窒息相关复苏技能的掌握,提高新生儿救治能力,提升产儿科协作,进一步完善新生儿死亡评审工作,降低新生儿死亡率。

Objective To explore the current situation of neonatal death in a city from 2017 to 2021,and the factors of its occurrence,so as to summarize the experience of neonatal death review,and reasonably formulate intervention countermeasures to reduce neonatal mortality.Methods Data related to neonatal deaths in a city from 2017 to 2021 was collected to carry out an analysis of review information related to neonatal deaths.Results From 2017 to 2021,there were 413,018 neonatal births and 491 neonatal deaths in the city.The neonatal mortality rate showed an overall decreasing trend,from 1.46‰in 2017 to 0.89‰in 2021,with a decreasing range of 0.57‰.From 2017 to 2021,among infant deaths,neonatal deaths accounted for 65.52%,63.29%,51.28%,63.57%,and 53.21%,respectively,while among children<5 years old,neonatal deaths accounted for 54.51%,48.88%,34.19%,45.88%,and 33.14%,respectively.The 5-year combined neonatal mortality rate was higher in boys(1.29‰)than in girls(1.07‰),with a statistically significant difference(P<0.05).The main causes of neonatal death were preterm birth or low birth weight,birth asphyxia,congenital heart disease,other congenital abnormalities,other neonatal diseases,sepsis,among which preterm birth or low birth weight was the first cause of death every year.The younger the gestational age at birth,the higher the mortality rate,and the difference in comparison was statistically significant(P<0.05).The lower the birth weight,the higher the mortality rate,and there was a statistically significant difference in the comparison of mortality rates of neonates with different birth weights(P<0.05).The neonatal mortality rate in fetal macrosomia was slightly lower than that in normal birth weight infants,and the difference was not statistically significant(χ^(2)=1.054,P=0.305>0.05).A total of 52 cases of typical,difficult,and common deaths were selected for neonatal death review at the municipal level from 2017 to 2021,and the review concluded that 7 cases(13.46%)were avoidable deaths,29 cases(55.77%)were avoidable deaths by creating conditions,and 16 cases(30.77%)were unavoidable deaths.Conclusion It is necessary to strengthen health education in pregnancy and perinatal period and management of high-risk pregnancies,improve midwifery skills,continuously promote the construction of neonatal units,strengthen medical and nursing staff's mastery of resuscitation skills related to neonatal asphyxia,improve neonatal rescue and treatment capabilities,enhance collaboration between obstetrics and pediatrics,further improve neonatal death reviews,and reduce neonatal mortality rate.