Factors Affecting the Mortality of Sick Newborns Admitted to Intensive Care Units

影響住入加護病房重病新生兒死亡的因素

鄒國英(Kuo-Inn Tsou Yau) ； 許瓊心(Chyong-Hsin Hsu)

《Acta Paediatrica Sinica》 40卷2期 (1999/04) Pp. 75-82

https://doi.org/10.7097/APS.199904.0146

摘要

爲要了解在台北地區影響住入加護病房新生兒死亡的因素，而依照顧病人的醫院層級進行一回顧性的資料分析。在台北地區共有19間醫院設有新生兒或小兒加護病房，其中14間加入此一資料登錄：3間爲地方醫院，7間爲區域醫院，4間爲醫學中心，針對1083個病房重新生兒的週産期及新生兒資料加以分析，其中60%爲早産兒，58%爲男嬰。母親轉診率爲7.8%，新生兒轉診率爲36.2%。59%的極低出生體重兒（出生體重不足1500公克）及66%的超低出生體重兒（出生體重不足1000公克）是在醫學中心治療的。50.9%的母親有高危險妊娠因素，11.4%出現胎兒窘迫，51.2%是以開刀方式生産，36.4%在産房內需用到氧氣吸入外的急救方法。此些病重新生兒最常見的問題爲週産期窒息、呼吸窘迫症、先天性心臓病、胎便吸入症候群及敗血症，40%需使用呼吸器治療。住入醫學中心的病重新生兒與住入其它兩類型醫院的病重新生兒相較，其孕婦轉診、胎兒窘迫、産房內急救、週産期窒息及壞死性腸炎的發生率較高，而胎便吸入症候群、敗轎症及氣胸的發生率較低。地區醫院的新生兒轉診率較其它醫院爲高。153個嬰兒死亡(14.4%)，最常見的死因爲敗血症(22.9%)。
在多變項分析結果顯示和嬰兒死亡相關的因素爲妊娠週數不足28週、先天性異常、敗血症、出生時需急救、新生兒轉診，先天性心臓病、醫院層級、超低出生體重兒，氣胸及高危險妊娠。此一研究結果顯示爲要進一步降低大台北地區病重新生兒的死亡率，需要良好規劃週産期及新生兒之照顧體系不、組織新生兒轉診系統、加強新生兒急救訓練、感染控制及精緻的呼吸治療照護。

關鍵字

新生兒加護照顧 ； 死亡率 ； 孕婦轉診 ； 新生兒轉診 ； 區域層級化

並列摘要

In order to provide better understanding of the factors affecting the mortality of sick newborns in the Taipei metropolitan area, data of newborns admitted to the intensive care units (ICU) were analyzed retrospectively according to the hospital type f care. Fourteen of the 19 hospitals with an ICU admitting sick newborns joined the data collection. 3 were local hospitals, 7 were regional hospitals and 4 were medical centers. Perinatal and neonatal data of 1083 sick newborns were analyzed: 60% were premature newborns and 58% were male newborns. The maternal referral rate was 7.8% and the neonatal transport rate was 36.2%. Fifty-nine percent of very low birth-weight newborns and 66% of extremely low birth-weight (ELBW) newborns were admitted to the medical centers. The two most common illnesses were perinatal asphyxia and respiratory distress syndrome. About 40% needed assisted ventilation. There were higher incidence of maternal referral, fetal distress, resuscitation in the delivery room, perinatal asphyxia, and necrotizing enterocolitis; lower incidence of meconium aspiration syndrome, sepsis and pneumothorax in newborns admitted to the medical center than those newborns admitted to other hospitals. A total of 153 newborns (14%) died. The most common cause of death was sepsis (22.9%). Multivariate logistic regression analysis revealed that factors significantly related to the mortality were gestational age＜28 weeks, congenital anomaly, sepsis, resuscitation in the delivery room, neonatal transport, congenital heart disease, hospital type of care, ELBW, pneutnothorax and high-risk pregnancy. The results of the study stress the importance of regionalization of perinatal and neonatal care, organization of neonatal transport system, newborn resuscitation training, infection control, and delicate ventilatory care in the further improvement of the outcome of sick newborns in the Taipei metropolitan area.

並列關鍵字

neonatal intensive care ； mortality ； maternal transport ； neonatal transport ； regionalization