潍坊市住院新生儿病死率及死亡原因的多中心研究

Mortality and cause of death of hospitalized neonates in Weifang,China: a multicenter study

摘要:

目的 探讨山东省潍坊市三甲医院近10年住院新生儿病死率及死亡原因的变化。 方法 回顾性纳入2012年1月1日至2021年12月31日山东省潍坊市3家三甲医院新生儿期死亡的461例新生儿为研究对象，收集有关临床资料，分析不同时间、胎龄（gestational age，GA）、出生体重（birth weight，BW）新生儿的病死率，比较前5年（2012~2016年）和后5年（2017~2021年）新生儿主要死亡原因及其变化。 结果 2012~2021年10年中3家医院共收治新生儿43 037例，其中死亡461例，病死率为1.07%。后5年新生儿病死率［0.96%（211/22 059）］显著低于前5年［1.19%（250/20 978）］（P<0.05）。新生儿病死率随胎龄、出生体重增加而降低（P<0.05）。前5年新生儿主要死因前3位依次是呼吸窘迫综合征（respiratory distress syndrome，RDS）、败血症、肺出血，后5年变迁为败血症、肺出血、RDS。GA<26周、BW<750 g新生儿前后5年的首位死因均为重度窒息；GA 26~<28周新生儿前后5年首位死因由RDS变迁为肺出血；BW 750~<1 000 g新生儿前后5年首位死因由肺出血变迁为RDS；GA 28~<32周和BW 1 000~<1 500 g新生儿首位死因前后5年均为RDS；GA 32~<37周和BW 1 500~<2 500 g新生儿前后5年首位死因由RDS变迁为败血症；GA 37~<42周和BW 2 500~<4 000 g新生儿前后5年首位死因均为败血症。 结论 山东省潍坊市三甲医院近10年新生儿的病死率呈下降趋势；病死率随胎龄的增加、出生体重的增高而降低；败血症、RDS、肺出血是新生儿死亡的主要原因，后5年RDS的致死率较前下降，而败血症和肺出血的致死率较前上升，因此减少败血症、RDS、肺出血的发生是降低新生儿病死率的关键。 ［中国当代儿科杂志，2022，24（9）：994-1000］

Abstract:

Objective To study the changes in the mortality rate and cause of death of hospitalized neonates in grade A tertiary hospitals in Weifang City of Shandong Province during a 10-year period. Methods A retrospective analysis was performed on 461 neonates who died in three grade A tertiary hospitals in Weifang City of Shandong Province from January 1, 2012 to December 31, 2021. The related clinical data were collected to examine the changes of neonatal mortality with time, gestational age (GA) and birth weight (BW). The main causes of death of the neonates were compared between the first 5 years (2012-2016) and the last 5 years (2017-2021) in the period. Results A total of 43 037 neonates were admitted from 2012 to 2021, among whom 461 died, resulting in a mortality rate of 1.07%. The mortality rate in the last 5 years was significantly lower than that in the first 5 years [0.96% (211/22 059 vs 1.19% (250/20 978); P<0.05]. The mortality rate of neonates decreased with the increases in GA and BW (P<0.05). In the first 5 years, the top three main causes of neonatal death were respiratory distress syndrome (RDS), sepsis, and pneumorrhagia, while in the last 5 years, the top three causes were sepsis, pneumorrhagia, and RDS. The leading cause of death was severe asphyxia for the neonates with a GA of <26 weeks and a BW of <750 g in both the first and last 5 years. For the neonates with a GA of 26-<28 weeks, the leading cause of death changed from RDS in the first 5 years to pneumorrhagia in the last 5 years. For the neonates with a BW of 750-<1 000 g, the leading cause of death changed from pneumorrhagia in the first 5 years to RDS in the last 5 years. For the neonates with a GA of 28-<32 weeks and a BW of 1 000-<1 500 g, the leading cause of death was RDS in both the first and last 5 years. For the neonates with a GA of 32-<37 weeks and a BW of 1 500-<2 500 g, the leading cause of death changed from RDS in the first 5 years to sepsis in the last 5 years. The leading cause of death was sepsis for the neonates with a GA of 37-<42 weeks and a BW of 2 500-<4 000 g in both the first and last 5 years. Conclusions The mortality rate of neonates in the grade A tertiary hospitals in Weifang City of Shandong Province has been decreasing in the past 10 years, and it decreases with the increases in GA and BW. Sepsis, RDS, and pneumorrhagia are the leading causes of neonatal death. The mortality rate caused by RDS decreases from the first 5 years to the last 5 years, while the mortality rate caused by sepsis or pneumorrhagia increases from the first 5 years to the last 5 years. Therefore, reducing the incidence rates of sepsis, RDS, and pneumorrhagia is the key to reducing neonatal mortality. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 994-1000