A Study On The Case Fatality Rate And Determinants Of Respiratory Failure In Neonates At A Gestational Age Of 34 Weeks Or More

Objects:To explore the case fatality rate and determinants of respiratory failure in neonates at a gestational age of 34 weeks or more, and provide scientific evidences for reducing the case fatality rate of neonatal respiratory failure.Methods:782 subjects with neonatal respiratory failure, which were treated in a 3A grade children hospital from January in 2008 to August in 2009,were analyzed by the clinical epidemiology method of cases analysis.Database was established by EpiData software 3.02.Descriptive statistical methods were used to analysis the basic features and case fatality rate of respiratory failure in neonates. Chi-square test was used to analyze the case fatality rate difference among groups. Multivariate non-conditional logistical regression model was used to screen the possible determinants of the case fatality rate.Results:Among 782 cases who were diagnosed as neonatal respiratory failure,the overall male/female ratio was 3.27:1,the average gestational age was(38.45±2.13)weeks, the average birth weight was(2908.28±607.14)g,the average hospitalization expenses was(13858.06±9797.61) yuan(RMB). Many kinds of diseases could lead to neonatal respiratory failure.In our study,it mainly included respiratory distress syndrome, pneumonia/sepsis, transient tachypnea, meconium aspiration syndrome and hypoxicischemic encephalopathy.The percent of these disease accounted for 22.2%,21.4%,21.0%,13.8% and 11.6%, respectively.Neonatal respiratory failure was mainly treated by conventional mechanical ventilation (CMV) (50.6%). The case fatality rate of neonatal respiratory failure of this study was 22.8%, which showed no gender difference. (x2=2.826, P=0.093).The case fatality rate of infants within 37 to 38 weeks and 39 to 41 weeks were 24.9% and 26.7% respectively,which were significantly higher than those of infants within 34 to 36 weeks(12.4%)(x2=10.089, P=0.001; x2=14.715, P=0.000). The case fatality rate with pneumonia/sepsis, hypoxic-ischemic encephalopathy and meconium aspiration syndrome were 32.5%,31.3% and 29.2% respectively, which were all higher than that with respiratory distress syndrome and transient tachypnea(15.5% and 9.6%).Multivariate non-conditional regression showed that congenial malformation(OR= 2.456), old age at admission of the NICU(OR=2.423), higher SNAPPE-Ⅱscores(OR=5.518) and mechanical ventilation (OR=3.806) were all with an increased risk for death. While mechanical ventilation time within 3.1 to 7.0 days had a relatively lower risk for the fatality of neonatal respiratory failure.Conclusion:The case fatality rate of respiratory failure in neonates at a gestational age of 34 weeks or more was higer.We should take necessary measures to prevent neonatal respiratory failure from death according to its associated determinants, and then improve the livability of neonatal respiratory failure.