背景:大多数新生儿死亡发生在低出生体重儿中。然而,在资源有限的设置中,这些婴儿通常会提前出院,这进一步使他们面临死亡。以前对早期出院后低出生体重儿发病率和死亡率的研究主要集中在极低出生体重儿,没有描述出院后新生儿死亡率。这项研究旨在确定乌干达Mulago国家转诊医院特殊护理婴儿病房出院的低出生体重新生儿的死亡率和预测因素。
方法:这是一项前瞻性队列研究,纳入了从Mulago国家转诊医院特殊护理婴儿病房出院的220名低出生体重新生儿。这些被跟踪到28个完整的生命天,或死亡,以先发生者为准。比例用于表达死亡率。为了确定死亡率的预测因子,进行Cox风险回归。
结果:在220名注册参与者中,216人(98.1%)完成了随访。研究参与者的平均胎龄为34±3周。出院时的中位体重为1,650g(IQR:1,315g-1,922g),其中46.1%小于胎龄。随访期间,14/216(6.5%)的新生儿死亡。出院体重小于1,200g的新生儿死亡率最高(7/34,20.6%)。死亡原因包括推测的新生儿败血症(10/14,71.4%),疑似吸入性肺炎(2/14,14.3%),和疑似婴儿床死亡(2/14,14.3%)。出院后的中位死亡时间为11天(范围3-16天)。死亡率的预测因素是出院体重低于1,200g(调整HR:23.47,p<0.001),5分钟Apgar评分小于7(调整HR:4.25,p=0.016),入院时诊断为新生儿败血症(调整HR:7.93,p=0.009)。
结论:Mulago国家转诊医院低出生体重新生儿的出院后死亡率很高。在新生儿中,小于1,200g的出院体重可能被认为是不安全的。护理人员对新生儿危险迹象的教育,以及预防败血症的措施,抽吸,出院前和随访期间应强调婴儿床死亡。
BACKGROUND: Most neonatal deaths occur among low birth weight infants. However, in resource-limited settings, these infants are commonly discharged early which further exposes them to mortality. Previous studies on morbidity and mortality among low birth weight infants after early discharge mainly focused on very low birth weight infants, and none described post-discharge neonatal mortality. This study aimed to determine the proportion and predictors of mortality among low birth weight neonates discharged from the Special Care Baby Unit at Mulago National Referral Hospital in Uganda.
METHODS: This was a prospective cohort study of 220 low birth weight neonates discharged from the Special Care Baby Unit at Mulago National Referral Hospital. These were followed up to 28 completed days of life, or death, whichever occurred first. Proportions were used to express mortality. To determine the predictors of mortality, Cox hazards regression was performed.
RESULTS: Of the 220 enrolled participants, 216 (98.1%) completed the follow-up. The mean gestational age of study participants was 34 ±3 weeks. The median weight at discharge was 1,650g (IQR: 1,315g -1,922g) and 46.1% were small for gestational age. During follow-up, 14/216 (6.5%) of neonates died. Mortality was highest (7/34, 20.6%) among neonates with discharge weights less than 1,200g. The causes of death included presumed neonatal sepsis (10/14, 71.4%), suspected aspiration pneumonia (2/14, 14.3%), and suspected cot death (2/14, 14.3%). The median time to death after discharge was 11 days (range 3-16 days). The predictors of mortality were a discharge weight of less than 1,200g (adj HR: 23.47, p <0.001), a 5-minute Apgar score of less than 7 (adj HR: 4.25, p = 0.016), and a diagnosis of neonatal sepsis during admission (adj HR: 7.93, p = 0.009).
CONCLUSIONS: Post-discharge mortality among low birth weight neonates at Mulago National Referral Hospital is high. A discharge weight of less than 1,200g may be considered unsafe among neonates. Caregiver education about neonatal danger signs, and measures to prevent sepsis, aspiration, and cot death should be emphasized before discharge and during follow-up visits.