| ObjectivesIn this study,we collected the clinical data of dead newborns hospitalized in The Third Affiliated Hospital of Zhengzhou University from January 1,2010 to December 31,2016,in order to analyze the neonatal mortality rate,causes of deaths and their changes during 2010~2016,to reveal risk factors related to the cause of deaths,and to provide suggestions for clinical practice to improve neonatal survival.Materials and MethodsThis is a retrospective study.In this study,we collected all neonates admitted to the neonatal department of our hospital who were dead during hospitalization from January 1,2010 to December 31,2016.Collecting medical records of these patients,including basic information about neonatal infants,perinatal period and the death situation,and refer to our hospital neonatal death report card and neonatal death case discussion records.We analyzed neonatal mortality rate and it’s trends,the main cause of death,and the perinatal risk factors.Statistical analyses was performed using Chi-square test and P<0.05 was considered as statistical significant.Results1.There were 28 616 patients admitted to our neonatal department in the past 7 years,of whom 384 cases were dead,the mortality rate was 1.34%.The mortality rate of premature infants was 1.88%,and the mortality rate of term infants was 0.88%,the difference was statistically significant(P<0.001).2.Mortality of boys was significantly increased than that of girls’,male:female was 1.59: 1.3.Among the 384 cases of neonatal death,53 cases died in 1 day,accounting for 13.80% of neonatal death,209 cases died in 2 to 7 days,accounting for 54.43%,late neonatal death in 122 cases,accounting for 31.77% of neonatal deaths.4.247 cases were premature infants,accounting for 64.32% of neonatal deaths,of whom 9.38% were very early premature infants,29.95% were 28 ~ 31+ 6 weeks,32~ 36+6 weeks accounted for 25.00%.5.238 cases were low birth weight infant,accounting for 61.98% of neonatal deaths,the extremely low birth weight infant accounted for 10.94%,and the birth weight of 1000~1499g accounted for 22.92%,birth weight of 1500~2499g accounted for 28.13%.The extremely low birth weight infant showed an upward trend,compared with 2010~2012,the mortality rate of the extremely low birth weight infant was increased signifiant in 2013~2016(P<0.05).6.In the past 7years,the first four causes of neonatal death were : premature and complications 165cases(42.97%),asphyxia and related complications 59 cases(15.36%),infections 52 cases(13.54%),birth defects 48cases(12.50%).7.Premature and complications was the first cause of death,the proportion of premature and complications of 2013~2016 increased significantly compared with 2010~2012(P<0.05);asphyxia and related complications there was a downward trend,the proportion of asphyxia and related complications of 2014~2016 decreased significantly compared with 2010~2013(P<0.05);infections and birth defects despite of the different position in different year,were the main cause of neonatal death.8.In the premature and complications,the first four leading causes of death were RDS(49.09%),sepsis(23.03%),NEC(10.30%)and pulmonary hemorrhage(7.88%).9.The first three leading causes of death of gestational age <28 weeks were RDS(58.33%),asphyxia and related complications(13.89%),sepsis and other infections(8.33%);gestational age of 28 ~ 31+6 weeks,the first three leading causes of death were RDS(37.39%),sepsis and other infections(24.35%),asphyxia and related complications(18.26%);the main causes of death in gestational age of 32~36+6 weeks were sepsis and other infections(25.00%),RDS and asphyxia-related complications(17.71%);the first three leading causes of death in the newborns with gestational age≥37 weeks were birth defects(27.01%),sepsis and other infections(25.55%),asphyxia and related complications(11.68%).10.The first three leading causes of death of neonatal birth weight less than 1500 g were RDS,asphyxia and related complications,sepsis and other infection;the main causes of death of birth weight in 1500 ~ 2499 g were as follows: sepsis and other infection(23.15%),RDS(19.44%),asphyxia and related complications(17.59%);the first three leading causes of death of birth weight in 2500 ~ 4000 g were sepsis and other infection(30.71%),birth defects(25.71 %),asphyxia and related complications(9.29%).11.The first four leading causes of death in the early stage of neonatal death were: premature and complication(45.80 %),neonatal asphyxia and related complications(19.08%),birth defects(11.83%),and infections(6.87%);the first three leading causes of neonatal death in 1 day were: neonatal asphyxia and related complications(39.62%),RDS(33.96%),birth defects(5.66%).12.Perinatal risk factors associated with newborn death mainly were: intrauterine distress(28.39%),premature rupture of membranes(23.18%),abnormal umbilical cord(21.88%),pregnancy induced hypertension or eclampsia(19.79%),abnormal umbilical cord(18.49%),the unhealthy pregnancy history(7.29%),placenta previa(7.03%),gestational diabetes mellitus(5.47%).Conclusions1.The first four leading causes of hospitalized neonatal death were: premature and complication,neonatal asphyxia and related complications,infections,and birth defects.The proportion of premature and complication increased after 4 years over the previous 3 years,the proportion of neonatal asphyxia and related complications decreased significantly after 3 years over the previous 4 years,and there was no significant change in the proportion of infections and birth defects in each year.2.The main causes of neonatal death according to different birth gestational age and birth weight was different. |
