| BackgroundHypoxic-ischemic encephalopathy (HIE) is one of the most harmful common diseases in neonatal period, and often causes neonatal death and neurologic developmental disorder. Of all yearly newborn infants of our country, about 3 million apneic infants suffer clinical sequelae including permanent brain damage such as cerebral palsy, epilepsy, mental retardation, visual disorder and auditory handicap and so on because of HIE, which cause deformities of different degrees and bring huge harm to family and society. The study on prevention and treatment of HIE of newborn infants has become a key topic that is directly related with national diathesis and life quality. In recent years, studies on etiological factor, pathogenesis, drug treatment and intervention measure of HIE have been greatly developed and extended to genic and molecular level. Especially sound three-level health care web of developed countries makes them greatly advantaged in HIE epidemiologic study and plays an important role in preventing incidence and sequelae of HIE. By exact and complete epidemiologic survey, a series of three-level prevention measures has been established, including perinatal care, fetal monitoring, and close cooperation and rehabilitative treatment in pediatrics department, thereafter the incidence rate, deformity rate and death rate are decreasing year by year. However, the study on HIE in our country lags behind a lot compared with that in foreign countries, hence the incidence rate, deformity rate and death rate are obviously higher than that in developed countries. Especially in HIE epidemiologic study, we still just rely on the small amount of statistic data from hospitals, and therefore the data are incomplete. The blank in HIE epidemiologic study has certainly become a great obstacle in instituting HIE prevention measures according to the current situation of our country.ObjectiveThrough the cooperation among the units in Guangdong Province and by means of hierarchical cluster sampling, we conducted HIE and apnoea neonatorum epidemiologic survey to study the incidence rate, deformity rate and death rat of HIE and apnoea neonatorum in our province and its endemic distribution. We discussed the impact of the relative factors in perinatal period on the occurrence and development of HIE, evaluated the efficacy and defects of current treatment measures, and performed a systematic and profound study on the preventive effect of collective intervention (such as fetal monitoring and cooperation in pediatrics department) on HIE and the medical economic situation of HIE, in the hope of achieving some progress in the clinical practice of HIE and instituting the standard diagnostics and treatment protocol and coordination network complied with the current situation of Guangdong Province.MethodThe study was a multi-center coordinated epidemiologic survey, and the 10 survey places were chosen from Guangzhou, Baoan District in Shenzhen, Qingyuan, Yangjiang, and Shanwei by means of hierarchical cluster sampling, with 3000 persons and 10 coordinated units (covering both urban and rural areas) from each survey place. The concrete protocol was: the inhabitants living in place covered by the coordinated unit was regarded as a sampling integer; separate the survey subjects into two hierarchies: urban dwellers and rural ones; select 1-2 district(s) from urban area and 2-3 towns from rural areas as the framework region for surveying, and pick up survey subjects at random according to the quantity requirements for survey samples. Each coordinated unit was required to survey 3000 samples, including 1000 urban dwellers and 2000 rural ones. The survey subjects were the newborn babies whose mothers were stationary population in this area with latest 3 years (03-1-1 to 05-12-31).On the basis of available references, the questionnaire was compiled with factors possibly related with HIE, including mother and offspring status (Table 1), HIE status (Table 2), apnoea neonatorum status (Table 3), premature birth and low birth weight infant status (Table 4), sequelae status and economic accounting (Table 5). Table 1 included①general status of mother②disease status of mother③examination before delivery④offspring status⑤status upon delivery. Table 2 included①status upon delivery②HIE symptoms and the treatment information③image analysis④intervention information in acute stage HIE. Table 3 included①status upon delivery②image analysis③intervention information in acute stage HIE. Table 4 included premature baby status, complication and treatment, follow-up information, conceptus age etc. Table 5 included general information, sequelae status (movement, visual capacity, acoustic sensibility, speech, intelligence etc.) and economic status (family income, treatment spending, expense origin, expense pressure) etc.The information of newborn babies were collected by local Maternal and Child Health institutions, hospitals, towns and villages and families in the latest 3 years (03-1-1 to 05-12-31). Table 1 was completed on the sampling scaled by urban and rural population. At corresponding hospitals, review mother and newborn baby cases to complete Table 2, 3 and 4, and further improve the data such as premature birth babies (or low birth weight infants) and HIE, apnoea neonatorum babies status, diagonostics, treatment etc. Complete the questionnaire of normal infants according to the ratio of 1:3 for comparison. Go to towns and villages and even the houses of premature birth babies (or low birth weight infants) and HIE, apnoea neonatorum babies to further investigate the disease status, treatment information and development status. The infants with abnormity in intelligence and physical development were transferred to Zhujiang Hospital for further examination, final diagnosis and necessary treatment, and complete the sequelae and economic accounting questionnaire. Meanwhile complete the questionnaire of normal infants according to the ratio of 1:3 for comparison.Investigation time was from 15th Jun. 2006 to 15th Mar. 2007.Investigation staffs were all professional ones assigned by cooperative units and with more than 3 years of professional clinical experience. And before the on-the-spot investigation, they had been centralizedly trained for 3 days under the organization of director of the host unit (Pediatrics of Zhujiang Hospital of Southern Medical University). 2 staffs independently inputted the data into computer, established database by EpiData, check the datas in the questionnaires, inputted them into database, and made consistency checking; made t and chi square tests respectively on measurement data and numeration data by statistical package of SPSS 11.0 for windows, and made Logistic regression analysis with incidences of HIE and apnoea neonatorum as dependent variable and with other factors of questionnaire as independent variable; analyzed relationships between every factor and incidences of HIE and apnoea neonatorum; and sought risk or protecting factor in incidences of HIE and apnoea neonatorum.Results 29086 valid questionnaire in total were reclaimed with the validation rate of 93.82%, about 96.95% of the proposed sample quantity. The mean age was 26.87 with the median of 26 years old, and the oldest mother was 56 years old while the youngest 18 years old. A large part of them are farmers- 15479 persons (56.1%), followed by workers/service industry with 3672 persons (13.3%). And a large part of them are junior middle school graduates with 20050 persons (72.7%), followed by senior middle school graduates 3249 persons (11.8%), primary school graduates 3025 persons (11.3%), university graduates 1103 persons (4.0%) etc. There were 19861 rural inhabitants, accounting for 68.1%, and 9335 urban inhabitants, accounting for 31.9%. The mean weight of the mothers were 61.85kg with the median of 63kg, and the heaviest was 90kg while the lightest 35kg; 17930 persons (61.2%) delivered their first babies, 7774 persons (26.5%) delivered their second babies, 2786 persons (9.5%) delivered their third babies, and 410 persons (1.4%) delivered their fourth babies. The mean conceptus age was 39.2 weeks with the median of 39.4 weeks, and the shortest conceptus age was 27.5 while the longest 44.5 weeks. The mean weight of the infants was 3089g with the median of 3100g, and the lightest was 1400g while the heaviest 5350g. There were 17254 baby boys, accounting for 58.9%, and 11600 baby girls, account for 39.6%.Incidence of HIE: among the 28716 newborn babies, there were 265 HIE cases with the incidence rate of 0.92%. Incidence in different areas: Guangzhou and Baoan 0.93%, Yangjiang 0.95%, Shanwei 0.94%, Qingyuan 0.83%. Analysis of HIE correlation factor: Logistic regression analysis showed that 10 factors including antepartum heart disease, anaemia, abortion frequency, gestation frequency, fetal position, alpha hypophamine, fetal head suction, time of last antenatal examination, examination hospital and premature rupture of membrane were correlated with HIE occurrence. Heart disease, anaemia, abortion frequency, fetal position, alpha hypophamine, fetal head suction and premature rupture of membrane are risk factors in HIE occurrence, while gestation frequency, last antenatal examination and higher grade hospital for examination are protective factors in HIE occurrence. The analysis on newborn babies show that amniotic fluid, birth weight, Apgar score at 5 min, skin color, breathe, heart beat at birth, Apgar score at 1 min, reflect at birth, vitality at first day etc. were related with HIE occurrence. Abnormity in amniotic fluid, Apgar score at 5 min, skin color, breathe, heart beat at birth, Apgar score at 1 min, reflect at birth, vitality at first day and increased birth weightwere risk factors in HIE occurrence.Incidence of apnoea neonatorum: Of valid investigated 28312 newborn infants, 2789 cases of apnoea neonatorum were observed, namely, incidence of apnoea neonatorum was 9.85%. Incidence of different regions: Incidence of apnoea neonatorum of Guangzhou and Bao'an was 9.63%, Yangjiang 11.84%, Sanwei 10.18%, and Qingyuan 9.12%. Analysis of correlative factors of apnoea neonatorum: Logistic regression analysis of parturient factors revealed that factors including antepartum heart isease, anaemia, heart disease and anaemia, miscarriage times, conception times, normal labor times, uterine-incision delivery times, fetal position and present, oxytocic hormone, vacuum extraction, the last antenatal examination time, antenatal examination hospital, antenatal examination times, delivery hospital, and second stage of labor and so on were correlative with incidence of apnoea neonatorum; heart disease, anaemia, miscarriage times, fetal position and present, oxytocic hormone, vacuum extraction, prolonged second stage of labor, and uterine-incision delivery times and so on were risk factors in incidence of apnoea neonatorum; and conception times, the last antenatal examination near to delivery, high-level antenatal examination hospital, antenatal examination times and normal labor times were protecting factors in incidence of apnoea neonatorum. And analysis of factors of newborn infant revealed amniotic fluid, amniotic fluid quantity, conceptus age, and cord around neck and so on were correlative with incidence of apnoea neonatorum; abnormal amniotic fluid, premature birth, and cord around neck and so on were risk factors in incidence of apnoea neonatorum; and amniotic fluid quantity was protecting factors in incidence of apnoea neonatorum.ConclusionIncidence of HIE of newborn infants in Guangdong province is 0.92%. Parturients with heart disease and anaemia, miscarriage times, fetal position, oxytocic hormone, vacuum extraction, and premature rupture of membrane and so on are risk factors in incidence of HIE; conception times, the last antenatal examination near to delivery, and high-level antenatal examination hospital are protecting factors in incidence of HIE; and abnormal amniotic fluid, increased birth weight, abnormal Apgar score at 5 minutes after birth, abnormal birth skin color, breath and heartbeat, abnormal Apgar score at 1 minute after birth, dysreflexia after birth, and abnormal consciousness on the first day after birth and so on are fetal risk factors in incidence of HIE.Incidence of apnoea neonatorum of newborn infants in Guangdong province is 9.85%. Parturients with heart disease and anaemia, miscarriage times, fetal position and present, oxytocic hormone, vacuum extraction, prolonged second stage of labor, and uterine-incision delivery times and so on are risk factors in incidence of apnoea neonatorum; conception times, the last antenatal examination near to delivery, high-level antenatal examination hospital, antenatal examination times and normal labor times are protecting factors in incidence of apnoea neonatorum; abnormal amniotic fluid, premature birth, and cord around neck and so on are fetal risk factors in incidence of apnoea neonatorum; and nondecreased amniotic fluid is protecting factors in incidence of apnoea neonatorum. |
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