住院期间早期与晚期新生儿死亡的临床特征比较

Comparative Analysis of Clinical Characteristics Between Early and Late Neonatal Deaths During Hospitalization

目的分析住院期间早期与晚期新生儿死亡病例的临床特征,为进一步降低新生儿死亡提供参考。方法回顾性收集某院2010年1月1日-2021年12月31日住院期间死亡的新生儿临床相关资料,按其死亡发生时间分为END组和LND,采用SPSS22.0对数据进行统计分析。结果共收治住院新生儿61205例,纳入分析的死亡新生儿125例,平均病死率为2.0‰,其中END84例(占67.2%),LND组41例(占32.8%)。END组较LND组中多胎妊娠(19.0%vs 39.0%)、规律产检(82.1%vs 95.1%)、产前应用糖皮质激素(40.5%vs 70.7%)及硫酸镁(23.8%vs 41.5%)的比例更低,组间差异均有统计学意义(均P<0.05)。END组比LND组的胎龄(31.49±5.13 w vs 29.73±3.29 w)、出生体重(1731.56±936.11 g vs 1393.90±526.09 g)更大,但合并重度窒息(36.9%vs 17.1%)、入院体温<36℃(56.0%vs 26.8%)、需有创机械通气(81.0%vs 53.7%)及血管活性药维持(65.5%vs 43.9%)的比例更高,两组差异均有统计学意义(均P<0.05)。END组与LND组死亡死因分布有所不同,败血症及出血性疾病是导致新生儿死亡的主要原因。结论END是住院新生儿死亡的主要类型;加强产前检查,合理应用产前激素与硫酸镁,预防出生窒息及低体温,积极处理感染及出血,将有助于进一步减少新生儿死亡。

Objectives This study aims to analyze the clinical characteristics of early and late neonatal deaths during hospitalization and provide evidence for further reducing neonatal mortality.Methods Clinical data on neonates who died during hospitalization in a hospital from January 1,2010 to December 31,2021 were retrospectively collected.All data were divided into END group and LND according to the time of death and SPSS22.0 was used for statistical data analysis.Results A total of 61,205 hospitalized neonates were treated and 125 dead neonates were included in the analysis,with an average mortality rate of 2.0‰,including 84 cases in the END group(accounting for 67.2%)and 41 cases in the LND group(accounting for 32.8%).Compared with the LND group,the END group had a lower proportion of multiple pregnancies(19.0%vs 39.0%),regular prenatal check-ups(82.1%vs 95.1%),prenatal glucocorticoids(40.5%vs 70.7%),and magnesium sulfate(23.8%vs 41.5%).The differences between groups were statistically significant(all P<0.05).The END group had a greater gestational age(31.49±5.13 w vs 29.73±3.29 w)and birth weight(1731.56±936.11 g vs 1393.90±526.09 g)than the LND group.but the proportion of severe asphyxia(36.9%vs 17.1%),temperature<36℃(56.0%vs 26.8%),the need for mechanical ventilation(81.0%vs 53.7%),and vasoactive drugs(65.5%vs 43.9%)at admission was higher.The differences between the two groups were statistically significant(both P<0.05).The distribution of causes of death was different between the END group and the LND group,with sepsis and hemorrhagic diseases being the main causes of neonatal death.Conclusions END is the main type of neonatal death during hospitalization.Strengthening prenatal examination,rational application of antenatal corticosteroids and magnesium sulfate,prevention of birth asphyxia and hypothermia,and active treatment of infection and hemorrhage will help reduce neonatal death.