Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida.
Pediatrix Medical Group, Center for Research and Education, Sunrise, Florida
Pediatrics. 2015 Jan;135(1):e59-65. doi: 10.1542/peds.2014-2967. Epub 2014 Dec 8.
Infant mortality is an indicator of overall societal health, and a significant proportion of infant deaths occur in NICUs. The objectives were to identify causes of death and to define potentially preventable factors associated with death as areas for quality improvement efforts in the NICU.
In a prospectively defined study, the principal investigator in 46 level III NICUs agreed to review health care records of infants who died. For each infant, the principal investigator reviewed the medical record to identify the primary cause of death and to look for preventable factors associated with the infant's death. Infants born at ≥22 weeks estimated gestational age who were born alive were included. Stillborn infants were excluded.
Data were collected on 641 infants who died. At lower gestational ages, mortality was most commonly due to extreme prematurity and the complications of premature birth (respiratory distress progressing to respiratory failure, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis). With increasing gestational age, the etiology of mortality shifted to hypoxic-ischemic encephalopathy and genetic or structural anomalies. Reviewers of clinical care identified 197 (31%) infants with potentially modifiable factors that may have contributed to their deaths.
The factors associated with death in infants admitted for intensive care are multifactorial and diverse, and they change with gestational age. In 31% of the deaths, potentially modifiable factors were identified, and these factors suggest important targets for reducing infant mortality.
婴儿死亡率是衡量整体社会健康水平的指标，而相当一部分婴儿死亡发生在新生儿重症监护病房（NICU）。本研究旨在确定死亡原因，并确定与死亡相关的潜在可预防因素，作为 NICU 质量改进工作的重点。
在一项前瞻性定义的研究中，46 家三级 NICU 的主要研究者同意审查死亡婴儿的医疗记录。对于每个婴儿，主要研究者审查病历以确定主要死亡原因，并寻找与婴儿死亡相关的可预防因素。纳入标准为胎龄≥22 周且出生时存活的婴儿。排除死产儿。
共收集了 641 名死亡婴儿的数据。胎龄较低时，死亡率通常归因于极度早产和早产并发症（呼吸窘迫进展为呼吸衰竭、颅内出血、坏死性小肠结肠炎和败血症）。随着胎龄的增加，死亡的病因转向缺氧缺血性脑病和遗传或结构异常。临床护理审查员确定了 197 名（31%）婴儿存在可能导致其死亡的可改变因素。
入住重症监护病房的婴儿死亡的相关因素是多因素和多样化的，且随胎龄变化而变化。在 31%的死亡病例中，发现了潜在的可改变因素，这些因素提示了降低婴儿死亡率的重要目标。
