Clinical epidemiological characteristics of neonatal respiratory failure in Children's Hospital of Hebei Province / 中华围产医学杂志

ABSTRACT

Objective To investigate the incidence,treatment and prognosis of neonatal respiratory failure (NRF) in the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province.Methods The medical data of 626 NRF newborns admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province from January 1st,2008 to December 31st,2008 were collected,and the pathogenesis of NRF,management,risk factors of their deaths and cost for the disease were studied.The results were compared with the national study in the same period and the local study of 2004-2005 by Chi-square test.Results During the 12 consecutive months,the incidence of NRF in neonatal intensive care unit was 38.9％ (626/1608).The mortality in hospital was 22.5％ (141/626),among which,most deaths (134,95.0％) occured after early discharge required by the parents.The mortality decreased by 14.7％ compared with that during 2004 2005 (37.2％,113/304),and was also lower than that (24.7％,1683/6864) in the national study at the same period.Pneumonia/sepsis ( 34.8 ％,218/626 ),neonatal respiratory distress syndrome ( 31.6 ％,198/626 ),and meconium aspiration syndrome (10.7％,67/626) were leading primary causes of NRF.The major complications were pneumonia/sepsis (5.4 ％,34/626),intracranial hemorrhage (4.6 ％,29/626) and persistent pulmonary hypertension (3.2％,20/626 ).The percentage of NRF babies requiring pulmonary surfactant rose from 14.1％ (43/304) during 2004-2005 to 23.6％ (149/626) in 2008,which almost reached the national level of 26.8％ (1840/6864).Pulmonary surfactant treatment was accepted by 70.2％ (139/198) patients with neonatal respiratory distress syndrome.12.1％ (24/198)of neonatal respiratory distress syndrome infant was administered immediate intubation-surfactant-extubation.Seventeen (2.7％) patients accepted nitric oxygen treatment.Nasal continuous positive airway pressure was given to 76.5％(479/626) patients,which was higher than before (47.1％,143/304).Conventional mechanical ventilation rate decreased from 72.7％ (221/304) to 49.8％ (312/626),and high frequency oscillatory rate increased from 0.7％ (2/304) to 10.5％ (66/626),which were similar to the national level.Of the 480 patients discharged after recovery,the mean time of hospital stay was (15.1 ± 4.0) days,and the mean medical cost was (12752 ± 5148) CNY.Conclusions The patient number increases and the medical skills and treatment methods of our hospital improve a lot.Utilization of pulmonary surfactant,nasal continuous positive airway pressure and high frequency oscillatory ventilation increase significantly.However,the burden of NRF is still heavy.