Araki Shunsuke, Tomioka Shinichi, Otani Makoto, Suga Shutaro, Ichikawa Shun, Matsuda Shinya, Fushimi Kiyohide, Kusuhara Koichi, Shirahata Akira
Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan.
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan.
J UOEH. 2019;41(3):295-302. doi: 10.7888/juoeh.41.295.
This study aimed to estimate the incidence and prognosis of neonatal disseminated intravascular coagulation (DIC) in Japan by analyzing data retrieved from a national administrative database. Clinically, the prognosis of DIC in neonates is poor, but there is little epidemiological data in Japan. This retrospective observational study identified patients diagnosed with neonatal DIC and who were registered in the Japanese diagnosis procedure combination (DPC) database between April 1, 2014 and March 31, 2016. The patients, who were diagnosed with neonatal DIC, included those with ICD-10 code D65 or P60 in primary and secondary diagnosis, with comorbid conditions existing at admission, and with complications occurring after admission. Of 78,073 neonates admitted to 1,474 neonatal intensive care units, 1,864 (2.4%) were diagnosed with DIC. There was no difference between sexes in incidence of DIC; the incidence of DIC was higher in extremely low birth weight infants (9.8%), and significantly higher than that in normal birth weight infants. The overall mean length of hospital stay was longer in neonates with DIC (69.5 days) than in those without DIC (32.6 days, P < 0.001). The number of deaths was 1,156 (1.5%). In-hospital mortality was significantly higher in neonates with DIC (14.1%) than in those without DIC (1.2%, P < 0.001), especially in premature babies. This nationwide study was the first report to investigate the incidence and in-hospital mortality of neonatal DIC in Japan. Neonatal DIC has a significant impact on prognosis, and its influence is greater in premature than in term infants.
本研究旨在通过分析从国家行政数据库中检索到的数据，估算日本新生儿弥散性血管内凝血（DIC）的发病率和预后情况。临床上，新生儿DIC的预后较差，但日本的流行病学数据较少。这项回顾性观察研究确定了2014年4月1日至2016年3月31日期间在日本诊断程序组合（DPC）数据库中登记的被诊断为新生儿DIC的患者。被诊断为新生儿DIC的患者包括在初次和二次诊断中具有ICD-10编码D65或P60、入院时存在合并症以及入院后出现并发症的患者。在1474个新生儿重症监护病房收治的78073例新生儿中，1864例（2.4%）被诊断为DIC。DIC的发病率在性别上无差异；极低出生体重儿的DIC发病率较高（9.8%），且显著高于正常出生体重儿。DIC新生儿的总体平均住院时间（69.5天）比未患DIC的新生儿（32.6天，P<0.001）更长。死亡人数为1156例（1.5%）。DIC新生儿的院内死亡率（14.1%）显著高于未患DIC的新生儿（1.2%，P<0.001），尤其是早产儿。这项全国性研究是首份调查日本新生儿DIC发病率和院内死亡率的报告。新生儿DIC对预后有重大影响，其影响在早产儿中比足月儿更大。
