Analysis of the correlative factors of neonatal deaths in neonatology department

Abstract

Objective To analyze the correlative factors of neonatal deaths in neonatology department to improve the treatment level and reduce the death rate of the hospitalized newborn patients. Method The medical records and death review data of the infants who died in the neonatology department of the Hospital from 2009 to 2015 were retrospectively reviewed. They were assigned to three groups according to the therapeutic measures before their death, including comfort care group, do not resuscitate (DNR) group and active treatment group. Gestational age, birth weight, postnatal age at death and the direct cause of death were compared between groups by χ2 test. Result A total of 337 infants were enrolled in this study. There were 112 cases (33.2%) in the comfort care group, 73 cases (21.7%) in the DNR group and 152 cases (45.1%) in the active treatment group. Compared to the proportion of the different group during 2009-2012, the proportion of the comfort care group during 2013-2015 significantly increased(38.9% vs.27.2%, P=0.023), and the proportion of the active treatment group significantly decreased (38.3% vs.52.5%, P=0.009), while the proportion of the DNR group showed no significant difference (22.9% vs.20.4%, P=0.580). The proportion of the comfort care group was significantly higher in the group of neonates who died in early neonatal period than that in the late neonatal period and post-neonatal period (42.9% vs.9.3%, P<0.001), while the proportion of the active treatment group and DNR group decreased(17.9% vs.30.9%, P=0.009; 39.2% vs.59.8%, P=0.001). The proportion the comfort care group increased with the decreasing gestational age and birth weight (P=0.001 and 0.002). Of the 34 term infants, the top two principle causes of death were severe asphyxia (41.1%, 14 cases) and congenital defects (32.4%, 11 cases). Of the 303 preterm infants, the top three direct causes of death were neonatal respiratory distress syndrome (31.4%, 95 cases), neonatal pulmonary hemorrhage (22.4%, 68 cases) and congenital defects (6.3%, 19 cases). Conclusion The proportion of comfort care and DNR was higher than the proportion of active treatment before the newborns′ death and it was relative to gestational age and birth weight. Preterm infants were the predominant population of the infant deaths in the neonatology department. Neonatal respiratory distress syndrome was the principle cause of death in preterm infants, and severe asphyxia was the main cause of death in term infants. Key words: Cause to death; Asphyxia neonatorum; Congenital abnormalities; Respiratory distress syndrome, newborn; Pulmonary hemorrhage