| Abstract: | 本文的主要目的，是在探討台中縣一歲以內嬰兒( infant)死亡各種原因
之潛在危險因子 ( potential risk factors)的相對重要性，並
且確認嬰兒時期出生特質與死亡危險因子的相 關。因而，應該進
行研究獲得嬰兒時期各種死亡危險因子並確認可能預防策略。倘若如此，
則可提供衛生機構擬訂臨床和預防醫學政策及其計劃的參考。
此項研究，出生日期自1994年1月1日至12月31日止一歲內所有死亡嬰兒為
研究對象。研 究期間，確認114個病例嬰兒與205個對照嬰兒。
死亡資料，取自台灣省衛生處編輯的死亡證 明書及為進一步分
析而儲存的電腦磁片。出生資料，取自台中縣各鄉鎮市衛生所的出生登記
申請書。此項研究的配對原則，是提供病例嬰兒與對照嬰兒相同性別、村
里與出生日至多相 差一個月內。使用EGRET於conditional
logistic regression model，進行配對病例-對照 分析，並且
估計粗勝算比與調整勝算比及其95%信賴區間。
此項結果，吾人比較嬰兒、新生兒及後新生兒後發現，嬰兒死亡的危險因
子有：懷孕次數 (≧3次)、分娩合併症、活產胎次(≧2次)、
低出生體重( ≦2500g)、低懷孕週數( ≦37週)、 先天異常、父
親教育程度(高中職)、住家坪數(26-50坪)、睡眠習慣(其他臥房)、母親
不打 小孩、住院、住加護病房、急救、看病、吃西藥、無新生
兒照顧、未按時預防接種、曾生 早產兒及曾有嬰兒死亡。新
生兒死亡之危險因子有：年青母親(≦19歲)、年青父親
(≦24歲)、分娩合併症、低出生體重、低懷孕週數、先天異常、住院、住
加護病房、急救、 未按時預防接種及曾生早產兒。後新生兒之
死亡危險因子有：低出生體重、低懷孕週數、父 親教育程度(高
中職)、母親不打小孩、住加護病房、看病、吃西藥、未按時預防接種及
曾有 嬰兒死亡。吾人比較早產兒與體重過低兒後發現新的危險
因子，就是早產兒的未足月低出生 體重與體重過低兒的足月低
出生體重。台中縣嬰兒死亡率為5.27 相當接近全國的5.07
嬰兒死因分析，新生兒的主要死因是先天異常與早產及其合併症而後新生
兒的主要死因是感 染性疾病與意外傷害。
本文獲得結論：新生兒與後新生兒死亡差異，新生兒與後新生兒仍是以生
物因子為主， 然而後新生兒受到社經與環境因子的影響較為明
顯。先天異常的嬰兒或新生兒，也是所有原 因中具有較高的特
定死因。社經與環境因子，增加後新生兒死亡危險。低懷孕週數及低出生
體重，則增加嬰兒、新生兒與後新生兒死亡危險。住加護病房及未按時預
防接種，是二項重 要醫療與醫療照顧徵兆。早產兒未足月的低
出生體重增加新生兒期死亡危險，而體重過低兒 足月的低出生
體重增加後新生兒期死亡危險。因此，這些嬰兒重要死亡危險因子可提供
衛生 機構擬定政策與參考。
The main purposes of this paper were to explore relative
significance of potential risk factors for infant
mortality less than one year of age in Taichung
County and to identify the characteristics at birth that were
associated with mortality during infancy. Therefore, the
research should be pursued to obtain a better
understanding of the various risk factors of
mortality during infancy and to affirm the possible preventive
strategies. Provided thus, these can offer the
health authority to draw up a policy and a scheme
for clinical and preventive medicine.
The study subjects were all of the infants less than one year of
age whose birthday was from January 1 to December
31 1994. Thus, 114 case infants and 205 control
infants were identified in our study. Mortal data were routinely
complied from all death certificates by the Taiwan Provincial
Center for Vital Statistics in the Department of
Health, and were stored on computer disks for further
analysis. Birth data were routinely complied from all birth
certificates by the health station for Hsings, Chens and
Shihs of Taichung County. A matched case-control study
was designed. One case infant was matched with two control
infants by means of the same sex, geographic region and
difference of age less than one month. Then, the EGRET
software was performed under the conditional
logistic regression model. Crude odds ratio and adjusted odds
ratio with its 95% CI were evaluated.
Compared in infant, neonatal and post-neonatal groups, there
were some risk factors found as follows. In infant
group, there were parity(≧3), labor
complication, live birth order(≧2), low birth weight(≦2500g),
low gestational age(≦37weeks), congenital anomaly,
lower father educational level, house size ( 26-50
Ping), and sleeping habit( other bedroom), mother''s not blaming
infants, hospitalization, hospitalization in NICU,
resuscitation, doctors'' consultation, medicine taking,
no neonatal care, no inoculation on schedule, previous
premature infants and previous infant death. In neonatal group,
there were young mother(≦19), young father(≦24), labor
complication, low birth weight, low gestational
age, congenital anomaly, hospitalization, hospitalization in
NICU, resuscitation, no inoculation on schedule and
previous premature infants. On post-neonatal group,
there were low birth weight, low gestational age, lower
father educational level, mother''s not blaming infants,
hospitalization in NICU, doctors'' consultation, medicine
taking, no inoculation on schedule and previous infant
death. Besides, compared with premature and small-for-dates
infants, low birth weight was an important risk factor,
but different meanings. To draw some
conclusions from this paper, the explanation of difference in
neonatal and post-neonatal death was mainly biological; however,
post-neonatal death was more apparently influenced by
socioeconomic and environmental factors. Infant or
neonatal congenital anomaly had higher cause-specific deaths for
all causes. Socioeconomic and environmental factors
increased the risk during the post-neonatal period.
Low gestational age and low birth weight increased the
risk for every one of 3 periods. To be hospitalized in NICU and
not to be inoculated on schedule were important
indicators of medical treatment and medical care.
Low birth weight of premature infants increased the risk during
the neonatal period; but that of small-for-dates infants
increased the risks during post-neonatal period.
Consequently, the important risk factors of infant
death considerably offered reference. |
