英格兰和威尔士 2013-2015 年感染导致新生儿死亡的回顾性分析。

Retrospective analysis of neonatal deaths secondary to infections in England and Wales, 2013-2015.

机构信息

Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK.

Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):363-369. doi: 10.1136/archdischild-2020-319093. Epub 2020 Nov 25.

DOI:10.1136/archdischild-2020-319093

PMID:33239280

Abstract

OBJECTIVE

To estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations.

DESIGN

Retrospective analysis of national electronic death registrations data.

SETTING

England and Wales.

PATIENTS

Neonates aged <28 days.

MAIN OUTCOME MEASURES

Overall and infection-related mortality rate per 1000 live births in term, preterm (28-36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003-2005.

RESULTS

The neonatal mortality rate during 2013-2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003-2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013-2015 (0.32/1000; n=669) was 20% lower compared with 2003-2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013-2015 and 11.5% (768/6700) during 2003-2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013-2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths.

CONCLUSIONS

Overall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.

摘要

目的

利用电子死亡登记系统估计整体和感染相关的新生儿死亡率以及相关病原体。

设计

对全国电子死亡登记数据的回顾性分析。

地点

英格兰和威尔士。

患者

<28 天的新生儿。

主要观察指标

足月、早产（28-36 周）和极早产（<28 周）新生儿的每 1000 例活产的总死亡率和感染相关死亡率；感染和特定病原体的贡献；与 2003-2005 年死亡率的比较。

结果

2013-2015 年新生儿死亡率（2.4/1000 活产；5095 例死亡）比 2003-2005 年（3.5/1000 活产；6700 例死亡）低 31%。2013-2015 年感染相关新生儿死亡率（0.32/1000；669 例）比 2003-2005 年（0.40/1000；768 例）低 20%。感染导致 2013-2015 年 13.1%（669/5095）的新生儿死亡，2003-2005 年 11.5%（768/6700）的新生儿死亡。在感染相关死亡中，44.2%（296/669）发生在足月新生儿中，19.9%（133/669）发生在早产儿中，35.9%（240/669）发生在极早产儿中。与足月新生儿（0.15/1000 活产）相比，2013-2015 年感染相关死亡率在早产儿（0.90/1000）中高 5.9 倍（95%CI 4.7 至 7.2），在极早产儿（28.7/1000）中高 188 倍（95%CI 157 至 223）。在 448 份（67%）记录中记录了病原体：400 份（89.3%）为细菌，37 份（8.3%）为病毒，11 份（2.4%）为真菌。在明确为细菌感染的 161 份记录中（49/161）有 30.4%（49/161）报告了 B 群链球菌（GBS），而在感染相关死亡中，GBS 占 7.3%（49/669）。