Zash Rebecca M, Ajose-Popoola Olubunmi, Stordal Ketil, Souda Sajini, Ogwu Anthony, Dryden-Peterson Scott, Powis Kathleen, Lockman Shahin, Makhema Joe, Essex Max, Shapiro Roger L
Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States; Botswana-Harvard AIDS Institute Partnership for HIV Research and Education, Gaborone, Botswana.
J Paediatr Child Health. 2014 Mar;50(3):189-95. doi: 10.1111/jpc.12454. Epub 2013 Dec 23.
Newborns admitted to neonatal units (NNUs) in resource-limited settings face a high risk of mortality, but the epidemiology of these deaths is poorly understood. We describe risk factors for NNU mortality in an area with high prevalence of human immunodeficiency virus (HIV).
We performed a prospective cohort study of infants admitted to the NNU at a public referral hospital in Gaborone, Botswana. The primary outcome was neonatal death, defined as death within 28 days of a live delivery. Cox proportional hazard models were used to evaluate risk factors for mortality.
From October 2008 to April 2009, 449 neonates were admitted to the NNU. Cumulative mortality was 24.5% (110/449). Factors associated with increased risk of death included lack of enteral feeding (hazard ratio (HR) 18.8, 95% confidence interval (CI) 10.3, 34.2), gestational age <28 weeks (HR 2.0, 95% CI 1.1, 3.8) and Apgar score <7 at 10 min (HR 2.5, 95% CI 1.5, 4.2). Among 348 (78%) infants who were fed, there was no difference in mortality between infants who were breastfed compared with those who were formula fed or had mixed feeding (P = 0.76). There was no significant mortality difference by HIV exposure status; 35 (28%) of 128 HIV-exposed infants died compared with 55 (21%) of 272 HIV-unexposed infants (P = 0.19).
This study identified low Apgar scores, extreme prematurity and lack of enteral feeding as the most important risk factors for mortality in this NNU setting. HIV exposure and formula feeding were not significantly associated with death in neonates who were very ill.
在资源有限地区入住新生儿重症监护病房（NNUs）的新生儿面临着很高的死亡风险，但对于这些死亡的流行病学情况了解甚少。我们描述了在人类免疫缺陷病毒（HIV）高流行地区新生儿重症监护病房死亡的危险因素。
我们在博茨瓦纳哈博罗内一家公立转诊医院对入住新生儿重症监护病房的婴儿进行了一项前瞻性队列研究。主要结局是新生儿死亡，定义为活产28天内死亡。采用Cox比例风险模型评估死亡危险因素。
2008年10月至2009年4月，449名新生儿入住新生儿重症监护病房。累积死亡率为24.5%（110/449）。与死亡风险增加相关的因素包括未进行肠内喂养（风险比（HR）18.8，95%置信区间（CI）10.3，34.2）、孕周<28周（HR 2.0，95%CI 1.1，3.8）以及10分钟时阿氏评分<7（HR 2.5，95%CI 1.5，4.2）。在348名（78%）接受喂养的婴儿中，母乳喂养婴儿与配方奶喂养或混合喂养婴儿的死亡率没有差异（P = 0.76）。HIV暴露状态对死亡率没有显著差异；128名HIV暴露婴儿中有35名（28%）死亡，而272名未暴露于HIV的婴儿中有55名（21%）死亡（P = 0.19）。
本研究确定低阿氏评分、极早产和未进行肠内喂养是该新生儿重症监护病房环境中最重要的死亡危险因素。HIV暴露和配方奶喂养与重病新生儿的死亡没有显著关联。
