Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Am J Perinatol. 2021 Aug;38(10):1048-1056. doi: 10.1055/s-0040-1701611. Epub 2020 Feb 26.
The aim of this study is to identify causes of neonatal intensive care unit (NICU) death in extremely low birth weight (ELBW) infants less than 1,000 g admitted in Chinese tertiary NICUs.
We retrospectively collected data on 607 ELBW infants from 39 level III NICUs from July 2016 to June 2019. The primary causes of death were compared among different gestation age, postnatal age groups, and areas with variable economic status.
Among all 607 ELBW NICU deaths, 47.1% were multiple gestation with high rate of in vitro fertilization (IVF) (43.3%); 53.4 and 34.1% received any or full course of antenatal corticosteroid (ACS). The most common causes of ELBW NICU death were respiratory distress syndrome-related neonatal respiratory failure (RDS-NRF, 43.5%), severe infection (19.1%), necrotizing enterocolitis or bowel perforation (9.4%), severe central nervous system injury (8.4%), and bronchopulmonary dysplasia-related respiratory failure (BPD-NRF, 7.7%). Causes of ELBW NICU death varied across postnatal age groups. RDS-NRF was the leading cause of early neonatal death, while severe infection in late neonatal death and BPD in postneonatal EBLW NICU death. RDS-NRF, severe brain injury, and asphyxia were most likely to die at early neonatal age (median age [interquartile range], 2 [0-5], 6 [3-9], and 3 [1-6] days, respectively) while severe infection and necrotizing enterocolitis (NEC) at late neonatal age, BPD-NRF at postneonatal age.
In Chinese tertiary NICUs, the major causes of death in extremely low birth weight infants were RDS, infection, NEC, brain injury and BPD, and they varied with postnatal age. Developing specific prevention strategies for identified causes of death in ELBW NICU may potentially improve ELBW survival.
本研究旨在确定在中国三级新生儿重症监护病房（NICU）收治的体重小于 1000 克的极低出生体重儿（ELBW）NICU 死亡的原因。
我们回顾性收集了 2016 年 7 月至 2019 年 6 月来自 39 家三级 NICU 的 607 例 ELBW 婴儿的数据。比较了不同胎龄、出生后年龄组和经济状况不同地区的主要死亡原因。
在所有 607 例 ELBW 新生儿重症监护病房死亡中，47.1%为多胎妊娠，其中体外受精（IVF）比例较高（43.3%）；53.4%和 34.1%接受了全程或部分产前皮质激素（ACS）治疗。ELBW 新生儿重症监护病房死亡的最常见原因是与呼吸窘迫综合征相关的新生儿呼吸衰竭（RDS-NRF，43.5%）、严重感染（19.1%）、坏死性小肠结肠炎或肠穿孔（9.4%）、严重中枢神经系统损伤（8.4%）和支气管肺发育不良相关的呼吸衰竭（BPD-NRF，7.7%）。ELBW 新生儿重症监护病房死亡的原因在不同的出生后年龄组中有所不同。RDS-NRF 是新生儿早期死亡的主要原因，而晚期新生儿死亡是严重感染，后期新生儿死亡是 BPD。RDS-NRF、严重脑损伤和窒息最有可能在新生儿早期死亡（中位数年龄[四分位距]分别为 2[0-5]、6[3-9]和 3[1-6]天），而严重感染和坏死性小肠结肠炎（NEC）在晚期新生儿死亡，BPD-NRF 在后期新生儿死亡。
在中国三级 NICU 中，极低出生体重儿死亡的主要原因是 RDS、感染、NEC、脑损伤和 BPD，且随出生后年龄而变化。针对 ELBW NICU 中确定的死亡原因制定特定的预防策略，可能有助于提高 ELBW 的存活率。
