การเปลี่ยนแปลงอัตราการตายทารกเกิดก่อนกำหนดมากมากในโรงพยาบาลสงขลานครินทร์ ประสบการณ์ 15 ปี

Abstract

Objectives: To evaluate predischarge neonatal mortality, morbidity, and associated risk factors in extremely preterm infants in a 15-year period in Songklanagarind Hospital. Study design: A retrospective cohort study was conducted in extremely preterm infants who were born and admitted in the NICU between January 2001 and December 2015. The study was divided into two periods: 2001-2009 and 2010-2015. The mortality rates by gestational age were compared by survival analysis with the Kaplan-Meier method with statistical significance set at p < 0.05. Results: The medical records of 135 extremely preterm infants were reviewed. Two infants were excluded due to congenital anomalies. The study enrolled 133 infants. Seventy-eight infants (58%) were female. The mortality rate was 49/133 (36.8%) and was significantly higher in the lower gestational age infants (p < 0.05). Comparing the years of 2004-2009 with 2010-2015, the mortality rates decreased from 44% to 32.5%, but this result was not statistically significant (p = 0.253). The most common causes of death during the first period and second period were respiratory distress syndrome (41%) and neonatal sepsis (46%), respectively. Multivariate analysis showed that the perinatal risk factors of mortality rate were lower gestation age and birth weight less than 750 grams (odds ratio = 6.8, 95% CI 0.9-0.9, p = 0.001). Conclusion: Although there was no significant trend in neonatal survival or composite morbidity over the 15 years, an improvement in survival was demonstrated with increased gestational age and birth weight more than 750 grams.