Etiologies of NICU Deaths
Etiologies of NICU Deaths
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DOI：
10.1542/peds.2014-2967
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发表时间：
2015-01-01
期刊：
影响因子：
8
通讯作者：
Spitzer, Alan R.
中科院分区：
文献类型：
--
作者：
Jacob, Jack;Kamitsuka, Michael;Spitzer, Alan R.
背景和目标：婴儿死亡率是整体社会健康的一个指标，婴儿死亡的很大一部分发生在新生儿重症监护室。目的是确定死亡原因，并确定与死亡相关的潜在可预防因素，作为 NICU 质量改进工作的领域。 方法：在一项前瞻性研究中，46 个 III 级 NICU 的主要研究者同意审查死亡婴儿的医疗保健记录。对于每个婴儿，主要研究者审查了病历，以确定死亡的主要原因并寻找与婴儿死亡相关的可预防因素。估计胎龄 >= 22 周出生且活产的婴儿也包括在内。死产婴儿被排除在外。 结果：收集了 641 名死亡婴儿的数据。在较低胎龄时，死亡最常见的原因是极度早产和早产并发症（呼吸窘迫进展为呼吸衰竭、脑室内出血、坏死性小肠结肠炎和败血症）。随着胎龄的增加，死亡的病因转向缺氧缺血性脑病和遗传或结构异常。临床护理审查员确定了 197 名 (31%) 婴儿可能存在导致其死亡的潜在可改变因素。结论：与入住重症监护的婴儿死亡相关的因素是多因素且多样化的，并且随着胎龄的变化而变化。在 31% 的死亡中，发现了潜在的可改变因素，这些因素表明了降低婴儿死亡率的重要目标。
BACKGROUND AND OBJECTIVES: Infant mortality is an indicator of overall societal health, and a significant proportion of infant deaths occur in NICUs. The objectives were to identify causes of death and to define potentially preventable factors associated with death as areas for quality improvement efforts in the NICU.METHODS: In a prospectively defined study, the principal investigator in 46 level III NICUs agreed to review health care records of infants who died. For each infant, the principal investigator reviewed the medical record to identify the primary cause of death and to look for preventable factors associated with the infant's death. Infants born at >= 22 weeks estimated gestational age who were born alive were included. Stillborn infants were excluded.RESULTS: Data were collected on 641 infants who died. At lower gestational ages, mortality was most commonly due to extreme prematurity and the complications of premature birth (respiratory distress progressing to respiratory failure, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis). With increasing gestational age, the etiology of mortality shifted to hypoxic-ischemic encephalopathy and genetic or structural anomalies. Reviewers of clinical care identified 197 (31%) infants with potentially modifiable factors that may have contributed to their deaths.CONCLUSIONS: The factors associated with death in infants admitted for intensive care are multifactorial and diverse, and they change with gestational age. In 31% of the deaths, potentially modifiable factors were identified, and these factors suggest important targets for reducing infant mortality.