CAUSES OF PERINATAL DEATHS IN PREMATURELY BORN INFANTS

Abstract

Cilj. Utvrditi uzroke perinatalne smrti prijevremeno rođene djece u Kliničkoj bolnici Split tijekom 1993. i 2002.–2003. godine. Metode. Pri određivanju uzroka smrti korištena je pojednostavljena modificirana Wigglesworthova klasifikacija. Patološki je analizirano 185 nedonoščadi, teže od 500 grama i iznad 22. tjedna trudnoće, koji su rođeni i ¬umrli u KB Split, obducirani na Zavodu za patologiju iste bolnice. Rezultati. Najčešći uzroci fetalne smrti prijevremeno rođene djece su normalno formirana macerirana mrtvorođenčad (42%) i stanja združena s nezrelošću (41%). Najčešći ¬uzrok ¬neonatalne smrtnosti je kombinacija više uzroka od kojih su najčeše bile kombinacije uzroka: hijalinomembranska bolest i intracerebralno krvarenje (12%), intracerebralno krvarenje i upala (9%), dok od pojedinačnih uzroka smrti najčešće su dijagnosticirane hijalinomembranska bolest i upala, u po 11% nedonošenih. U 1993. godini najčešći uzroci smrti su: intracerebralno krvarenje, upala i atelektaza pluća, dok u 2002.–03. godini prevladavaju malformacije združene s nekim od stanja vezanih uz nezrelost. Između dva ispitivana razdoblja statistički značajna razlika postoji u učestalosti svih ¬uzroka, osim u kombinacijama hijalinomembranske bolesti, intracerebralnog krvarenja i upale. Posteljica je bila bez promjena u 45% slučajeva, a najčešća patološka promjena posteljice je upala (30%). Zaključak. Najčešći uzroci neonatalne smrti prijevremeno rođene djece su stanja združena sa nezrelošću, pojedinačna ili češće u kombinaciji. Najčešće dijagnosticirani pojedinačni uzroci smrti bili su hijalinomembranska bolest i upala (u po 11%), potom intracerebralno krvarenje i atelektaza (u po 10%), dok je najčešći kombinirani uzrok bila hijalinomembranska bolest i intracerebralno krvarenje (u 12%), nedonoščadi.Aim of this study was to determine causes of perinatal death of premature infants, who were born at the Clinical Hospital Split, in the year 1993. and 2002–03. Methods. Simplified and modified Wigglesworth classification of perinatal death was used. The study included 185 preterm born infants over 500 g and/or 22 weeks of gestation, born and died at the Clinical Hospital Split and postmortem examined at the Department of Pathology and Cytology of the same Hospital. The causes of neonatal death, between two analyzed periods (1993 and 2002–03.), were compared. Results. The most frequent causes of fetal death in prematurely born infants according to the simplified Wigglesworth classification were: normally formed macerated stillbirths (42%) and conditions associated with immaturity (41%). The most frequent pathohistological cause of neonatal death in prematurely born infants was a combination of more findings: hyaline ¬membrane disease and intracerebral haemorrhage (12%), intracerebral haemorrhage and inflammation (9%), while the most frequent single causes of death were hyaline membrane disease (11%) and inflammation (11%). In 1993 intracerebral haemorrhage, inflammation and lung atelectasis were the most frequent causes of perinatal death. During 2002–03 malformations and other findings were most frequently established. Between two analyzed periods significant difference was found in all causes of neonatal death, except in a combination of: hyaline membrane disease, intracerebral haemorrhage and inflammation. Placentas from the prematurely born infants were usually normal (45%). The most ¬frequent placental pathohistological finding from prematurely born infants was inflammation (30%). Conclusion. The most prevalent cause of fetal and neonatal death within preterm infants was condition associated with immaturity, alone or as a part of multiple findings. The most frequent single causes of death were: hyaline membrane disease and inflammation, each of them in 11%, followed by intracerebral haemorrhage and atelectasis (each found in 10%), while the most ¬frequent combined cause of death was hyaline membrane disease and intracerebral haemorrhage (12%)