Xu Feng-Dan, Kong Xiang-Yong, Feng Zhi-Chun
Department of Pediatrics, Bayi Children's Hospital Affiliated to Clinical Medical College in PLA Army General Hospital of Southern Medical University, Beijing 100700, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2017 Feb;19(2):152-158. doi: 10.7499/j.issn.1008-8830.2017.02.005.
To investigate the mortality rate and the cause of death of hospitalized neonates.
The clinical data of 480 neonates who died between January 2008 and December 2014 were collected. The mortality rates of neonates with different gestational ages, birth weights, sexes, and ages in days were analyzed. The abnormal perinatal factors, cause of death, and death grade were summarized.
Among the 41 910 hospitalized neonates, 480 (1.1%) died, and the mortality rates of preterm infants and full-term infants were 1.7% and 0.7%, respectively. The mortality rate of hospitalized neonates decreased from 1.4% in 2008 to 1.1% in 2014, and the decrease was more apparent in the preterm infants with a gestational age of <32 weeks and the neonates with a birth weight of <1 000 g. Among preterm infants and full-term infants, those with a lower gestational age tended to have a higher mortality rate, but post-term infants had an increased mortality rate. The infants with a lower birth weight tended to have a higher mortality rate. Male neonates had a significantly higher mortality rate than female neonates (1.31% vs 0.92%; P<0.05). Among the neonates who died, 61.3% had definite abnormal perinatal factors, including abnormal amniotic fluid (29.4%), premature rupture of membranes (16.9%), placental abnormality (16.9%), fetal intrauterine distress (14.0%), and abnormal umbilical cord (12.3%). Among the 480 neonates who died, 57 (11.9%) died within 24 hours after birth, 181 (37.7%) died within 2-7 days, and 242 (50.4%) died within 8-28 days. The three most common causes of death were infection, birth defect, and respiratory distress syndrome. The most common cause of death was respiratory distress syndrome in 2008-2011 and infection in 2012-2014. Respiratory distress syndrome was the most common cause of death in preterm infants with a gestational age of <32 weeks, neonates with a birth weight of <1 500 g, and neonates who died with 24 hours; infection was the most common cause of death in neonates with a gestational age of 32-42 weeks, neonates with a birth weight of 1 500-4 000 g, and neonates who died within 8-28 days. Neonatal asphyxia was the major cause of death in post-term infants. Inevitable deaths (grade 1) accounted for 54.4%, deaths that could be avoided under certain conditions (grade 2) accounted for 23.3%, and deaths caused by concerns about prognosis or economic reasons (grade 3) accounted for 22.3%.
In recent years, the treatment of neonates has gradually improved, and the mortality rate of neonates is gradually decreasing, especially in neonates with low gestational age and birth weight. Important measures for reducing the mortality rate in neonates include enhancing perinatal management, reducing abnormal perinatal factors, preventing infection, and increasing parents' confidence in treatment.
探讨住院新生儿的死亡率及死亡原因。
收集2008年1月至2014年12月期间死亡的480例新生儿的临床资料。分析不同胎龄、出生体重、性别及日龄新生儿的死亡率。总结围产期异常因素、死亡原因及死亡分级。
在41910例住院新生儿中，480例（1.1%）死亡，早产儿和足月儿的死亡率分别为1.7%和0.7%。住院新生儿死亡率从2008年的1.4%降至2014年的1.1%，在胎龄<32周的早产儿和出生体重<1000g的新生儿中下降更为明显。在早产儿和足月儿中，胎龄越低死亡率往往越高，但过期产儿死亡率有所增加。出生体重越低的婴儿死亡率往往越高。男性新生儿死亡率显著高于女性新生儿（1.31%对0.92%；P<0.05）。在死亡的新生儿中，61.3%有明确的围产期异常因素，包括羊水异常（29.4%）、胎膜早破（16.9%）、胎盘异常（16.9%）、胎儿宫内窘迫（14.0%）和脐带异常（12.3%）。在480例死亡新生儿中，57例（11.9%）在出生后24小时内死亡，181例（37.7%）在2至7天内死亡，242例（50.4%）在8至28天内死亡。三大最常见死亡原因是感染、出生缺陷和呼吸窘迫综合征。2008 - 2011年最常见死亡原因是呼吸窘迫综合征，2012 - 2014年是感染。呼吸窘迫综合征是胎龄<32周的早产儿、出生体重<1500g的新生儿及出生后24小时内死亡新生儿最常见的死亡原因；感染是胎龄32 - 42周的新生儿、出生体重1500 - 4000g的新生儿及出生后8 - 28天内死亡新生儿最常见的死亡原因。新生儿窒息是过期产儿主要死亡原因。不可避免死亡（1级）占54.4%，在某些情况下可避免的死亡（2级）占23.3%，因预后或经济原因导致的死亡（3级）占22.3%。
近年来，新生儿治疗逐渐改善，新生儿死亡率逐渐下降，尤其是低胎龄和低出生体重的新生儿。降低新生儿死亡率的重要措施包括加强围产期管理、减少围产期异常因素、预防感染以及增强家长对治疗的信心。
