Multicenter assessment of mortality risk in the neonatal intensive care unit

Kamuran Suman, E. Gök, P. Bütün, Zafer Bütün, Musa Büyük, M. Suman
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Abstract

OBJECTİVE: In neonatal intensive care, mortality is a source of great pressure and sadness on the family and the doctor. By its nature, intensive care services serve as a support point on the fine line between life and death. Minimizing this mortality is one of our colleagues' primary goals. For this reason, this study, it is aimed to determine the causes that have an effect on mortality and to minimize these causes with subsequent evaluations. MATERİAL AND METHOD: Our study covers the retrospective data of the babies who died in the neonatal unit between 2015 and 2019. In this context, patients who were born at 22 weeks and older and were hospitalized in the neonatal unit or needed resuscitation in the delivery room were included. Our colleagues from three different hospitals participated in this study with the patients they registered. One of these centers is a training and research hospital and the other centers are state hospitals with busy delivery rooms. Babies lost in utero were not included in the study. Maternal and newborn mortality risk factors were recorded in the perinatal period. In addition, family demographic characteristics, causes of death, and mortality rates were recorded. These recorded data were analyzed according to Wiggleswort's mortality classification. Snappe ll scoring was used to evaluate the probability of death. RESULT: Of the 3112 babies admitted to our neonatal units during the aforementioned four years, we lost 79. When we examined the records of the newborns we lost, prematurity stood out as the most common cause of death. The causes we see less frequently, such as fatal congenital anomalies and severe genetic anomalies incompatible with life, drew attention as their incidence decreased. When we focus, we found that the loss rate was higher in the early neonatal period than in other periods. İn further detail, we see that the highest mortality rate occurred on the first day. While losses due to prematurity were more common in the first weeks of gestation, it was observed that the causes of death changed as the weeks of gestation progressed, and the incidence of genetic diseases and congenital anomalies increased. CONCLUSİON: As we know, the causes of neonatal intensive care losses are diverse, although their frequency varies. The most important determinant of this diversity is gestational age. In this retrospective study, we found that causes such as prematurity and congenital anomalies were among the most common causes. Similar to our results, many international publications have shown that these causes have the highest mortality rate. Improving follow-up and care in the perinatal period has an impact on reducing the causes of mortality we listed. Although not all causes can be eliminated, there are ethical debates about abortion for diseases incompatible with life.
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新生儿重症监护病房死亡风险的多中心评估
OBJECTİVE:在新生儿重症监护中,死亡率给家庭和医生带来了巨大的压力和悲伤。从本质上讲,重症监护服务是生与死之间的一个支撑点。尽量减少这种死亡率是我们同事的主要目标之一。因此,本研究旨在确定影响死亡率的原因,并在随后的评估中尽量减少这些原因。MATERİAL与方法:我们的研究涵盖了2015年至2019年期间在新生儿病房死亡的婴儿的回顾性数据。在这种情况下,22周及以上出生并在新生儿病房住院或需要在产房复苏的患者包括在内。我们来自三家不同医院的同事与他们登记的病人一起参与了这项研究。其中一个中心是培训和研究医院,其他中心是拥有繁忙产房的州立医院。在子宫内丢失的婴儿不包括在这项研究中。在围产期记录产妇和新生儿死亡的危险因素。此外,还记录了家庭人口特征、死亡原因和死亡率。这些记录的数据根据Wiggleswort的死亡率分类进行分析。采用Snappe评分法评价死亡概率。结果:在上述四年中,3112名婴儿入住我们的新生儿病房,我们失去了79名。当我们检查我们失去的新生儿的记录时,早产是最常见的死亡原因。我们很少看到的原因,如致命的先天性异常和与生命不相容的严重遗传异常,随着发病率的下降而引起人们的注意。当我们集中注意力时,我们发现新生儿早期的损失率高于其他时期。İn更详细地说,我们看到第一天的死亡率最高。虽然早产造成的死亡在妊娠最初几周更为常见,但据观察,随着妊娠几周的进展,死亡原因发生变化,遗传疾病和先天性异常的发生率增加。CONCLUSİON:正如我们所知,新生儿重症监护损失的原因多种多样,尽管其频率各不相同。这种多样性最重要的决定因素是胎龄。在这项回顾性研究中,我们发现早产和先天性异常等原因是最常见的原因。与我们的研究结果类似,许多国际出版物表明,这些原因的死亡率最高。改善围产期的随访和护理对减少我们列出的死亡原因有影响。虽然并非所有的原因都可以消除,但对于因与生命不相容的疾病而堕胎的问题,存在着伦理上的争论。
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