Analysis of In-hospital Neonatal Death in the Tertiary Neonatal Intensive Care Unit in China: A Multicenter Retrospective Study.
BACKGROUND
Globally, the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%. Differences of cause in neonate death exist in different regions as well as in different economic development countries. The specific aim of this study was to investigate the causes, characteristics, and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit (NICU) of China.


METHODS
All the dead neonates admitted to 26 NICUs were included between January l, 2011, and December 31, 2011. All the data were collected retrospectively from clinical records by a designed questionnaire. Data collected from each NICU were delivered to the leading institution where the results were analyzed.


RESULTS
A total of 744 newborns died during the 1-year survey, accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals. Preterm neonate death accounted for 59.3% of all the death. The leading causes of death in preterm and term infants were pulmonary disease and infection, respectively. In early neonate period, pulmonary diseases (56.5%) occupied the largest proportion of preterm deaths while infection (27%) and neurologic diseases (22%) were the two main causes of term deaths. In late neonate period, infection was the leading cause of both preterm and term neonate deaths. About two-thirds of neonate death occurred after medical care withdrawal. Of the cases who might survive if receiving continuing treatment, parents' concern about the long-term outcomes was the main reason of medical care withdrawal.


CONCLUSIONS
Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age. Our study showed the majority of neonate death occurred in preterm infants. Cause of death varied with the age of death and gestational age. Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310051, China.
Chen-Hong
CH
Wang
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310051, China.
Li-Zhong
LZ
Du
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310051, China.
Xiao-Lu
XL
Ma
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310051, China.
Li-Ping
LP
Shi
Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
Xiao-Mei
XM
Tong
Department of Neonatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Hong
H
Liu
Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Guo-Fang
GF
Ding
Department of Neonatology, Gansu Provincial Maternity and Children-care Hospital, Lanzhou, Gansu 730050, China.
Bin
B
Yi
Department of Neonatology, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530003, China.
Xin-Nian
XN
Pan
Department of Neonatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
Dan-Ni
DN
Zhong
Department of Neonatology, Guiyang Maternal and Child Health Care Hospital, Guiyang, Guizhou 550003, China.
Ling
L
Liu
Department of Neonatology, Harbin Children's Hospital, Harbin, Heilongjiang 150010, China.
Mei
M
Li
Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, Hebei 050031, China.
Cui-Qing
CQ
Liu
Department of Neonatology, Hubei Maternity and Child Heath Hospital, Wuhan, Hubei 430070, China.
Shi-Wen
SW
Xia
Department of Neonatal Intensive Care Unit, Inner Mongolia Maternal and Child Health Hospital, Huhhot, Inner Mongolia 010030, China.
Hong-Yun
HY
Wang
Department of Neonatology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi 330006, China.
Ling
L
He
Department of Pediatric, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
Kun
K
Liang
Department of Neonatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 320100, China.
Xiao-Yu
XY
Zhou
Department of Neonatology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, China.
Shu-Ping
SP
Han
Department of Neonatal Intensive Care Unit, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China.
Qin
Q
Lyu
Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
Yin-Ping
YP
Qiu
Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao, Shandong 266000, China.
Ruo-Bing
RB
Shan
Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
De-Zhi
DZ
Mu
Department of Neonatology, Shenzhen Children's Hospital, Shenzhen, Guangdong 518026, China.
Xiao-Hong
XH
Liu
Department of Neonatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Si-Qi
SQ
Zhuang
Department of Neonatology, Tianjin Children's Hospital, Tianjin 300074, China.
Jing
J
Guo
Department of Neonatology, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
Li
L
Liu
Department of Neonatology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, China.
Jia-Jun
JJ
Zhu
Department of Neonatology, Zhengzhou Children's Hospital, Zhengzhou, Henan 450007, China.
Hong
H
Xiong
D002423:Cause of Death; D002681:China; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D066087:Perinatal Death; D012189:Retrospective Studies