Prevalence of major morbidities and outcome of all hospitalized neonates. A retrospective cohort study of Huai’an neonatal survivals

Reliable data for causal implication of neonatal survival in China are lacking. We assumed that by analyzing surviving data of in-hospital neonatal care based on all livebirths in Huai’an, prevalence of neonatal morbidity, mortality and causal relations may be derived comprehensively. Data of all regionally hospitalized neonates were retrospectively linked with corresponding whole livebirths (59,056) in 2015 as a cohort. Diagnoses of diseases and causes of deaths were redefined and categorized. Disease patterns, prevalence of morbidities, case-fatality rate (CFR), and cause-specific mortality rate (CSMR) referring to livebirths were presented. Perinatal and disease-specific risks of death were estimated by multivariable logistic regression. In 7,960 (134.8‰) hospitalized patients, 168 (2.1%) died in hospital (2.85‰ of livebirths). Prevalence of major morbidities were 76.8‰ hyperbilirubinemia, 57.4‰ pneumonia, 32.7‰ intraventricular hemorrhage, 20.7‰ sepsis, 20.2‰ birth asphyxia, 9.69‰ congenital anomalies (CA), and 5.30‰ respiratory distress syndrome (RDS). The CFR (CSMR) of major diseases were 30.4% (0.12‰) meconium aspiration syndrome, 17.6% (0.22‰) necrotizing enterocolitis, 14.1% (0.75‰) RDS, 9.09% (0.88‰) CA, 5.26% (0.07‰) bronchopulmonary dysplasia, 1.71% (0.36‰) sepsis and 1.51% (0.31‰) asphyxia. Overall mortality rates were 4.6% and 6.8% in the preterm and low birthweight, and >50% in those of <28 week gestation or <1000 g birthweight, respectively. Mortality risks associated with the perinatal and neonatal morbidities were markedly declined with variable magnitude by multivariable regression models. The in-hospital neonatal survival datafile, depicted as the prevalence of major morbidities and CSMR of livebirth population in Huai’an, denoted overall and specific quality and efficiency of the perinatal-neonatal care system. Its concept and methodology should be relevant, and outcome extrapolated, to other countries or domestic regions, with similar socioeconomic development.

目前中国关于新生儿生存因果关联的可靠数据仍较为匮乏。本研究基于淮安市所有活产儿数据，对住院新生儿护理的生存资料进行分析，以期全面阐明新生儿发病、死亡情况及其因果关联。本研究将2015年淮安市所有住院新生儿数据与同期对应的全部活产儿（共59056例）进行回顾性关联，构建队列研究。对疾病诊断及死亡原因进行重新定义与分类。报告了以活产儿为参照的疾病谱、发病率、病例病死率（case-fatality rate, CFR）以及病因别病死率（cause-specific mortality rate, CSMR）。通过多变量logistic回归分析，估算围产期及疾病特异性死亡风险。在7960例住院新生儿（占活产儿的134.8‰）中，168例（2.1%）于住院期间死亡，占活产儿总数的2.85‰。主要疾病的发病率分别为：高胆红素血症（hyperbilirubinemia）76.8‰、肺炎（pneumonia）57.4‰、脑室内出血（intraventricular hemorrhage）32.7‰、败血症（sepsis）20.7‰、出生窒息（birth asphyxia）20.2‰、先天性畸形（congenital anomalies, CA）9.69‰以及呼吸窘迫综合征（respiratory distress syndrome, RDS）5.30‰。主要疾病的病例病死率（CFR）及病因别病死率（CSMR）分别为：胎粪吸入综合征30.4%（0.12‰）、坏死性小肠结肠炎17.6%（0.22‰）、呼吸窘迫综合征（RDS）14.1%（0.75‰）、先天性畸形（CA）9.09%（0.88‰）、支气管肺发育不良5.26%（0.07‰）、败血症1.71%（0.36‰）以及窒息1.51%（0.31‰）。早产及低出生体重儿的总体病死率分别为4.6%和6.8%，而妊娠<28周或出生体重<1000g的新生儿总体病死率则超过50%。经多变量回归模型分析，与围产期及新生儿疾病相关的死亡风险均有不同程度的显著降低。本研究的住院新生儿生存数据集，以淮安市活产儿群体的主要疾病发病率及病因别病死率为核心指标，可反映围产期-新生儿护理体系的整体及专项质量与效率。该研究的设计理念与研究方法，对社会经济发展水平相似的其他国家或国内地区具有参考价值，其研究结果亦可推广至此类地区。