The Establishment Of Neonatal Database And Analysis Of 15490 In-patient Cases

Objective:After more than 50 years of unremitting effort,we have made great achievements in neonatology.In the past ten years,all aspects in neonatology including disease spectrum,diagnosis,treatment,mortality,morbidity and etc are changing rapidly.The neotologists are eager to know what has happened in the NICU. And all the clinical strategies should be made adapted to these changes.However, analysis of such huge clinical data could only rely on the establishment of database and network.The purpose of this thesis is to evaluate the possibility of establishment of neonatal database in China and to analyze 15490 in-patient cases during the past 5 years based on this database.Methods:(1) Clinical form of all in-patient newboms was designed.(2) A standardized neonatal clinical database was constructed to collect all the information extracted from clinical forms.We carried out a preliminary study to test the compliance of operators and whether it could contain all the major information.After making the final edition of form and database based on results of preliminary study, we started full-scale study.(3) Data collection:15490 infants who were admitted to the Division of Neonatology from January 1^st 2004 to December 31st 2008 were enrolled in the study.(4)Analysis:A retrospective research was made in this database. Statistical analyses were performed in this database.Results:(1) Basic characteristics:The majority of the 15490 patients were male full-term newborns.Gestational age was 37.6±3.2wk,birth weigh was 2895.5±788.5g (range 500-6200g),and the overall length of stay was 12.7±12.7d.(2) Maternal history:Only 64.7%(n=10017) mothers of newborns had regular prenatal care. Pregnancy induced hypertension,intrauterine infections and gestational diabetics accounted for the most common diseases during pregnancy.And the preterm had the higher incidence of maternal diseases(p＜0.001).22.4%(n=547) mothers of GA less than 34wk received antenatal dexamethasone treatment.17.9%(n=2770) at 1 min postnatal age and 7.3%(n=1121) at 5 min postnatal age had an Apgar score less than 7.(3) Manifestation:The major symptoms of neonates were dyspnea(24.2%), cyanosis(12.0%),jaundice(10.6%),fever(9.4%),vomiting(7.9%) and seizure (3.2%).(4) Disease spectrum:There were preterm(30.4%,n=4712), hyberbilirubinemia(28.5%,n=4412),infectious pneumonia(26.6%,n=4123), asphyxia(17.7%,n=2738),aspiratory pneumonia(15.6%,n=2419),wet lung(9.7%, n=1506),PDA(8.9%,n=1374),PFO(8.7%,n=1350) sepsis(8.4%,n=1300) and congenital syphilis(7.2%,n=1109) among the highest incidence of neonatal diseases. Recently,respiratory diseases(56.9%) and infectious diseases(46.3%) played important roles in neonatal diseases.Nosocomial infection rate in our division and NICU were 13.4%and 14.2%,respectively.(5) Treatment:67%(n=10380) were admitted to NICU.22.7%(n=3511) was given oxygen,8.3%(n=1285) were treated with CPAP and 9.1%(n=1409) with ventilator.Only 0.5%(n=75) received inhaled NO therapy.There was obviously increment in using pulmonary surfactant from 2004 to 2008.36.2%(n=5607) were accepted photo therapy and 8.8%(n=1367) with blood transfusion.1%(n=148) use central lines.39.5%(n=6123) got intravenous nutrition. (6) Prognosis:The prognosis of all newborns was good.The infants who discharged with doctor's approval accounted for 92.3%(n=14298) and died for 1.5%(n=225).Conclusions:(1) This study suggests that the establishment of neonatal clinical database is feasible and it do help studying the epidemiology,outcomes and health services of neonates which can improve efficacy and efficiency of neonatal care.(2) The proportion of preterm infants increased annually,and meanwhile preterm related diseases increased a lot in the past five years.(3) Gestational age and birth weight are highly associated with the length of stay,hospital costs,treatment and prognosis.(4) Preterm,hyperbilirubinemia,pneumonia,asphyxia and aspiration pneumonia listed top 5 among all the neonatal diseases.The disease spectrum became broader.The proportion of complicated cases,metabolic diseases and congenital malformation increased.(5) Critically ill newborns became an important part of all in-patient cases, therefore,the length of NICU stay prolonged and the use of CPAP and mechanical ventilation increased.(6) The prognosis of all in-patient newborns was good,and mortality rate was 1.5%.