| Objectives Neonatal survival is a big public-health issue for the world. In2010, neonatal deaths are mainly caused by preterm birth complications, infections, and intrapartum-related complications worldwide. Reduction of neonatal mortality in China has been great in the past20years. However, there are still a huge number of children dying in the first4weeks of life. Birth asphyxia, preterm birth complications, and congenital abnormalities are currently the main causes of neonatal deaths in China.In this study, we collect the clinical data of dead newborns hospitalized in our hospital, in order to analyze the neonatal mortality rate and causes of deaths as well as their changes during these years, to reveal risk factors related to the cause of deaths, and to provide suggestions for clinical practice to improve neonatal survival.Materials and Methods This is a retrospective, single-centered study. In this study, we collect all neonates admitted to the neonate department of our hospital who were dead during hospitalization or in the emergency room within one week after discharging against medical advice from January1,1999to December31,2012. Collecting medical records of these patients, and according to neonatal death reporting card as well as death review meeting records, we describe the characteristics of these patients, analyze neonatal mortality rate and causes of deaths, compare changes between the year1999-2005and2006-2012, and reveal risk factors related to the cause of deaths. We use Stata11and SPSS Statistics19for analysis.Results There are45345patients admitted to our department in the past14years, of which812cases are dead. The mortality rate is1.79%.Neonatal mortality rate decline significantly during2001-2002(P=0.000), but remain steadily after2002.The proportions of very-low-birth-weight (P=0.000) and very-preterm (P=0.003) infants are increased in2007-2012compared with1999-2006. The main causes of deaths are preterm birth complications (31.40%), congenital abnormalities (20.94%), infections (14.41%), birth asphyxia (10.34%), and respiratory diseases (7.02%). In2006-2012, both the proportions of preterm birth complications (P=0.000) and congenital abnormalities (P=0.013) are increased compared with1999-2005, well the proportion of infections (P=0.000) decreased. Hypertension during pregnancy (OR=3.520,95%CI:2.126-5.826), premature rupture of membranes (OR=1.556,95%CI:1.020-2.374), and multiple pregnancies (OR=3.994,95%CI:2.450-6.512) are risk factors of dying from preterm birth complications. Fetal distress (OR=2.154,95%CI:1.235-3.757) is a risk factor of dying from birth asphyxia. Early neonatal deaths account for63.38%of deaths in the neonatal period,39.62%of which occur within1-day-old and are mainly caused by neonatal respiratory distress syndrome or birth asphyxia. The proportion of infections is higher in the late neonatal deaths (24.49%). Preterm deaths are mainly caused by infections (21.33%), neonatal respiratory distress syndrome (17.54%) and necrotizing enterocolitis (14.22%). Congenital abnormalities (35.03%) and Infections (22.46%) are the top causes for term baby deaths. Post term infants are mainly dead from birth asphyxia (45.83%).Conclusions Preterm birth complications and congenital abnormalities are the main causes of neonatal deaths in our hospital, and their proportions in causes of deaths are both increasing. Hypertension during pregnancy, premature rupture of membranes, and multiple pregnancies are risk factors of dying from preterm birth complications. Fetal distress is a risk factor of dying from birth asphyxia. The causes of deaths are different between preterm, term and post term infants and in different periods of life. |
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