Quality of life of families and siblings of children with cerebral palsy treated at a reference neurorehabilitation center in Brazil.

OBJECTIVES: To investigate the associations between caregivers' burden, family quality of life (QoL), and siblings' QoL in Brazilian families of children with cerebral palsy, and to analyze siblings' QoL using as a parameter the QoL of typically developed Brazilian children. METHODS: It was a cross-sectional study. The 212 families, 212 caregivers and 131 siblings completed the Family Quality of Life Scale, Burden Interview, and KIDSCREEN-27 Child and Adolescent Version and Parents Version questionnaires at a neurorehabilitation center in southeast Brazil. Univariable and multivariable models were used. RESULTS: Family QoL significantly worsened as caregivers' burden increased (95 % CI -0.66 to -0.38). Caregivers' burden was significantly lower with increasing family QoL scores (95 % CI -0.52 to -0.30). Self-reported siblings' QoL was significantly worse than that of their typically developed peers (95 % CI -7.6 to -3.6). Self-reported siblings' QoL was significantly lower as siblings' age (95 % CI -2.52 to -0.59) and caregivers' burden (95 % CI -0.35 to -0.05) increased. Parent-reported siblings' QoL was significantly lower with increasing caregivers' burden (95 % CI -0.45 to -0.16) and higher as family QoL increased (95 % CI 0.09 to 0.37). CONCLUSIONS: The cross-sectional nature of these data precludes any statement of causality. Family QoL worsened with higher caregivers' burden levels. Lower caregivers' burden scores were associated with a higher family QoL. Siblings' QoL was impaired as compared to typically developed peers, worse among older siblings, and as caregivers' burden increased and better with higher family QoL levels. Future multicenter studies may validate the generalizability of the present findings.

Quality of life of families and siblings of children and adolescents with meningomyelocele.

BACKGROUND: Children with meningomyelocele may require continuous care. Consequently, there is a risk for caregiver burden and impact on family quality of life (QoL), including siblings' QoL. Some studies analysed caregivers' burden and family QoL separately. However, none of these studies evaluated siblings' QoL and the associations between these three dimensions. This study investigated the associations between caregivers' burden, family QoL and siblings' QoL in Brazilian families of children with meningomyelocele and its correlations with sociodemographic, functional and clinical variables. Siblings' QoL was specifically assessed using as a parameter the QoL of typically developed Brazilian children. METHODS: One hundred and fifty families, 150 caregivers and 68 siblings completed the Family Quality of Life Scale, Burden Interview, KIDSCREEN-27 Child and Adolescent Version and Parents Version questionnaires. RESULTS: Most families and caregivers reported a high family QoL and a low caregiver burden. Family QoL was significantly lower as caregivers' burden increased. Caregiver's burden was significantly lower with increasing family QoL levels. Self-reported siblings' QoL was significantly worse than that of typically developed peers. There were no significant differences between self and parent-reported siblings' QoL. Self-reported siblings' QoL was significantly worse as their age increased and better with increasing family QoL levels. Parent-reported siblings' QoL was significantly worse with increasing levels of caregiver's burden and significantly better as family QoL increased. There were no significant associations with functional and clinical variables. CONCLUSIONS: Despite the cross-sectional nature of the available data precludes any statements of causality, our results reinforce the relevance of knowing the factors that influence the QoL of families and siblings of children and adolescents with meningomyelocele and the relevance of actions aimed at reducing caregivers' burden, improving family QoL and meeting siblings' individual needs. Future multicenter studies may validate the generalizability of our findings.

Bronchopulmonary dysplasia: temporal trend from 2010 to 2019 in the Brazilian Network on Neonatal Research.

OBJECTIVE: To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN: Retrospective cohort with data retrieved from an ongoing national registry. SETTING: 19 Brazilian university public hospitals. PATIENTS: Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES: Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS: Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION: The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.

Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey.

OBJECTIVE: Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. STUDY DESIGN: Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. RESULTS: In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. CONCLUSION: Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS. KEY POINTS: · Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..

Evaluation of the effectiveness of antenatal corticoid in preterm twin and single pregnancies: a multicenter cohort study.

BACKGROUND: The effects of antenatal corticosteroids (ANSs) on twins are not well established. OBJECTIVE: To determine the impact of ANS use according to the number of fetuses. METHODS: Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014.Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. RESULTS: About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R2 Twins = 0.78; 95% CI = 0.69-0.86) (Adj R2 Singles = 0.79; 95% CI = 0.62-0.99). Reduced peri-intraventricular hemorrhage (Adj R2 Twins = 0.54; 95% CI = 0.36-0.78) (Adj R2 singles = 0.54; 95% CI = 0.36-0.78); and early sepsis reduction on single and triplex gestations (Adj R2 triplex = 0.51; 95% CI = 0.27-0.94) (Adj single R2 = 0.51; 95% CI = 0.27-0.94) were observed. CONCLUSIONS: This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.

Evaluation of usability of a neonatal health information system according to the user's perception / Avaliação da usabilidade de um sistema de informação em saúde neonatal segundo a percepção do usuário

ABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

RESUMO Objetivo: Mensurar o grau de satisfação de profissionais de saúde quanto à usabilidade de um sistema de informação em saúde neonatal e identificar os fatores que podem influenciar na satisfação do usuário frente à usabilidade. Métodos: Estudo transversal e exploratório realizado com 50 profissionais de saúde integrantes dos centros da Rede Brasileira de Pesquisas Neonatais. Para avaliação da usabilidade foi utilizado o instrumento System Usability Scale entre fevereiro e março de 2017. Realizou-se a análise estatística descritiva e inferencial das variáveis coletadas, com a finalidade de descrever a amostra, quantificar o grau de satisfação dos usuários e identificar as variáveis associadas ao grau de satisfação do usuário em relação à usabilidade. Resultados: Da população avaliada, 75% era do sexo feminino, com idade média 52,8 anos, 58% com pós-graduação (doutorado); tempo médio da última formação de 17 anos; área de atuação em medicina (neonatologia), grau intermediário de conhecimento em informática e tempo de utilização média do sistema de 52 meses. Quanto à usabilidade, 94% avaliaram o sistema como "bom", "excelente" ou "melhor impossível". A usabilidade do sistema não foi associada a idade, sexo, escolaridade, profissão, área de atuação, nível de conhecimento em informática e tempo de uso do sistema. Conclusões: O grau de satisfação do usuário do sistema informatizado de saúde foi considerado bom. Não foram identificados fatores demográficos que influenciassem sua avaliação.

EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER'S PERCEPTION.

OBJECTIVE: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. METHODS: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. RESULTS: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. CONCLUSION: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

T-piece versus self-inflating bag ventilation in preterm neonates at birth.

OBJECTIVE: To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. DESIGN: Pragmatic prospective cohort study. SETTING: 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. INTERVENTIONS: Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome. RESULTS: 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). CONCLUSION: This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.

Early Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants: A Retrospective Analysis.

The causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P < 0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.

Factors associated with red blood cell transfusions in very-low-birth-weight preterm infants in Brazilian neonatal units.

BACKGROUND: Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. METHODS: A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. RESULTS: A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. CONCLUSIONS: The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.

Comparação da mortalidade neonatal em recém-nascidos de muito baixo peso ao nascimento, em maternidades do Município do Rio de Janeiro, Brasil / Comparison of neonatal mortality in very low birth weight newborns at maternity hospitals in the city of Rio de Janeiro, Brazil

Foi realizada a comparação das taxas de mortalidade neonatal em quatro maternidades do Município do Rio de Janeiro, Brasil. A população estudada foi de recém-nascidos com peso inferior a 1.500g. O instrumento utilizado foi um questionário com dados informados pela mãe e o prontuário médico. Foram calculados, para cada instituição, as Razões Padronizadas de Mortalidade (RPM) com o método direto e indireto, tendo como padrão a distribuição por peso do National Institute of Child Health and Human Development Neonatal Research. A amostra final apresentou 487 recém-nascidos. As padronizações pelo método direto e indireto mostraram elevadas taxas de mortalidade em todas as instituições; as que apresentaram a maior quantidade de recém-nascidos nas faixas com os menores pesos, foram aquelas que mostraram os menores valores de RPM. A menor razão de mortalidade por faixa de peso foi encontrada na faixa de peso entre 500 e 749g. Os resultados da RPM estão inversamente associados ao quantitativo populacional de recém-nascidos nas faixas com os menores pesos. Os coeficientes de mortalidade mostraram taxas altas, principalmente nas faixas de peso mais elevados. Os resultados apontam para uma qualidade deficiente na atenção perinatal.

[Comparison of neonatal mortality in very low birth weight newborns at maternity hospitals in the city of Rio de Janeiro, Brazil]. / Comparação da mortalidade neonatal em recém-nascidos de muito baixo peso ao nascimento, em maternidades do Município do Rio de Janeiro, Brasil.

This study was a comparison of neonatal mortality rates in four maternity hospitals in the city of Rio de Janeiro, Brazil. The study population consisted of newborns with birth weight below 1,500 g. The research instrument was a questionnaire with data reported by the mother and collected from the patient record. For each maternity hospital the standardized mortality ratio (SMR) was calculated using the direct and indirect method, using the weight distribution of the National Institute of Child Health and Human Development Neonatal Research as the standard. The final sample consisted of 487 newborns. Standardizations by the direct and indirect method showed high mortality rates in all four institutions; those showing the largest number of newborns in the lowest weight brackets were those with the lowest SMR values. The lowest mortality ratio by weight bracket was in the 500 to 749 g group. The SMR results were inversely associated with the quantitative population of newborns in the lowest weight brackets. The mortality coefficients showed high rates, especially in the highest weight brackets. The results indicate deficient quality of perinatal care.

[Evaluation of neonatal mortality in very low birth weight infants in four maternity hospitals in the Municipality of Rio de Janeiro, Brazil]. / Avaliação dos óbitos neonatais em recém-nascidos de muito baixo peso em quatro maternidades no Município do Rio de Janeiro, Brasil.

The objective of this study was to describe the causes of neonatal mortality in four maternity hospitals in the Municipality of Rio de Janeiro, Brazil. The study included all very low birth weight newborns during the first complete 27 days of life. The distribution of live newborns and all very low birth weight newborns as well as the percentage of deaths per hospital and the totals were described. The study estimated total and specific neonatal mortality coefficients and assessed viability, time, and causes of death. The study sample consisted of 487 newborns. We found an 11.3 neonatal mortality rate (8.3 early neonatal and 2.9 late neonatal). Viability for all very low birth weight newborns was above 26 weeks' gestation and birth weight of 749 g. Mortality was low in the first three days of life, mainly in the first day, and higher from the fourth to the 28th day. Sepsis was the main cause of neonatal mortality. Health systems managers should focus on: diagnosis and control of perinatal infections; decreasing neonatal hospital infection by reducing overcrowding in the nursery; and routine pathological investigation on all placentas in very low birth weight newborns as well as routine autopsies in case of death.

Avaliacão dos óbitos neonatais em recém-nascidos de muito baixo peso em quatro maternidades no Município do Rio de Janeiro, Brasil / Evaluation of neonatal mortality in very low birth weight infants in four maternity hospitals in the Municipality of Rio de Janeiro, Brazil

O objetivo foi descrever as causas de morte em recém-nascidos de muito baixo peso, em quatro maternidades do Município do Rio de Janeiro, Brasil. No estudo longitudinal foram incluídos todos os recém-nascidos de muito baixo peso até completarem 27 dias de vida. Descrita a distribuicão dos recém-nascidos vivos, recém-nascidos de muito baixo peso, percentual de óbitos por maternidades e o seu total, foram calculados os coeficientes de mortalidade neonatal total e seus componentes. Viabilidade e tempo de mortes foram avaliados. O estudo incluiu 487 recém-nascidos. A mortalidade neonatal foi de 11,3ë, a precoce de 8,3ë e a tardia de 2,9ë. A viabilidade de recém-nascidos de muito baixo peso foi superior a 26 semanas gestacionais e 749g de peso. A mortalidade foi baixa nos primeiros três dias de vida, especialmente no 1º, e elevada do 4º ao 28º. Principal causa da morte foi a sepsis. As acões dos gestores de saúde devem ser direcionadas na melhoraria do diagnóstico; controle das infeccões perinatais; diminuicão da contaminacão hospitalar dos recém-nascidos, com reducão da superpopulacão nas enfermarias; estudo rotineiro das placentas e necropsia de recém-nascidos de muito baixo peso.

[Factors associated with neonatal mortality among very low birthweight newborns in four maternity hospitals in the city of Rio de Janeiro, Brazil]. / Fatores associados à morte neonatal em recém-nascidos de muito baixo peso em quatro maternidades no Município do Rio de Janeiro, Brasil.

In Brazil, neonatal mortality is the most common cause of infant mortality. The majority of deaths occur in very low birthweight newborns. This longitudinal study assesses factors associated with mortality risk in very low birthweight newborns during the first 27 days of life. Relative risk of mortality was assessed for each variable, and the most statistically significant variables were selected for the multivariate model, in which odds ratios were calculated using logistic regression. Factors associated with decreased mortality risk were: prenatal corticosteroid (OR = 0.40; 90%CI: 0.23-0.74) and total parenteral nutrition (OR = 0.06; 90%CI: 0.02-0.15). Factors associated with increased mortality risk were: male gender (OR = 2.19; 90%CI: 1.27-4.00); maternal hemorrhage (OR = 4.28; 90%CI: 1.27-14.46); use of mechanical ventilation (OR = 18.83; 90%CI: 5.15-68.87); CRIB (OR = 4.48; 90%CI: 2.43-8.27); and birthweight. Selective use of prenatal corticosteroid should be encouraged in order to reduce neonatal mortality and morbidity.

Fatores associados à morte neonatal em recém-nascidos de muito baixo peso em quatro maternidades no Município do Rio de Janeiro, Brasil / Factors associated with neonatal mortality among very low birthweight newborns in four maternity hospitals in the city of Rio de Janeiro, Brazil

Os recém-nascidos de muito baixo peso representam a grande maioria das mortes no período neonatal, constituindo o maior percentual da mortalidade infantil no Brasil. Este estudo, do tipo longitudinal, incluiu um total de 487 recém-nascidos e propôs uma análise dos fatores associados à mortalidade em recém-nascidos de muito baixo peso até completarem 27 dias de vida. Foram calculados os riscos relativos de óbito para cada uma das variáveis estudada, e as que se mostraram estatisticamente significativas foram selecionadas para o modelo multivariado, no qual se calcularam as razões de chances (OR) com a regressão logística. Os fatores associados à diminuição do risco de morte foram: uso de corticosteróide antenatal (OR = 0,40; IC90 por cento: 0,23-0,74) e uso de nutrição parenteral total (OR = 0,06; IC90 por cento: 0,02-0,15). Os fatores associados ao risco de morte foram: recém-nascido do sexo masculino (OR = 2,19; IC90 por cento: 1,27-4,00); hemorragia materna (OR = 4,28; IC90 por cento: 1,27-14,46) e uso de ventilação mecânica (OR = 18,83; IC90 por cento: 5,15-68,87); escore de CRIB (OR = 4,48; IC90 por cento: 2,43-8,27) e peso ao nascimento. O uso de corticosteróide antenatal deve ser mais difundido, visando à diminuição da morbi-mortalidade neonatal.

Fatores associados à mortalidade em recém-nascidos de muito baixo peso ao nascimento (inferior a 1500g) em maternidades do município do Rio de Janeiro / Factors ssociaties to the mortality in newborn with birth weight in Rio de Janeiro

A mortalidade neonatal representa o maior percentual da mortalidade infantil no Brasil. Os recém-nascidos de muito baixo peso ao nascimento (RNMBPNs) se apresentam como a grande maioria dessas mortes. Este estudo teve como objetivo descrever as causas e analisar os fatores associados ao risco de morte em RNMBPNs, em maternidades do município do Rio de Janeiro. Foram incluídos e acompanhados, no estudo, todos os RNMBPNs até completarem 27 dias de vida em quatro maternidades do município do Rio de Janeiro. Foi descrita a distribuição dos recém-nascidos (RNs) vivos, a dos RNMBPNs e o percentual de óbitos por maternidades e o seu total. Foram calculados os coeficientes de mortalidade neonatal total e seus componentes. Foram avaliados ainda a viabilidade e o tempo de morte. Calculou-se a mortalidade neonatal padronizada pelos métodos direto e indireto. Para avaliação dos fatores associados ao risco de óbitos foram selecionadas variáveis relativas ao nível socioeconômico, à história reprodutiva e obstétrica e as características do RN e da sua assistência recebida. Foram calculados os riscos relativos (RR) de óbito e os intervalos de confiança de 95 para cada variável estudada e as que se mostraram estatisticamente significativas foram selecionadas para o modelo multivariado no qual se calculou os Odds Ratios (OR) e intervalos de confiança de 95 por cento. O estudo incluiu um total de 487 RNs. A mortalidade neonatal encontrada foi de 11,32 por cento, sendo a precoce de 8,3 por cento e a tardia de 2,9 por cento. No primeiro dia de vida foram observados pouco óbitos. A viabilidade de RNMBPNs foi superior a 26 semanas gestacionais e 749g de peso ao nascimento. A principal causa de mortalidade neonatal foi a sepsis, tendo sido mais freqüente na faixa de peso, ao nascimento, entre 750 e 1.249g. Os fatores associados à diminuição do risco de morte foram: mãe primogesta (OR = 0,46; IC 0,24-0,93); uso de corticosteróide antenatal (OR = 0,39; IC 0,20-0,79); uso de nutrição parenteral total (OR = 0,06; IC 0,02-0,15). Os fatores associados ao risco de morte foram: RN do sexo masculino (OR = 2,01; IC 1,07-3,78); hemorragia materna (OR = 5,07; IC 1,41-18,19) e o uso de ventilação mecânica (OR = 28,83; IC 5,59-148,84) e o peso ao nascimento. A sepsis neonatal é a principal causa de óbito. O peso ao nascimento e o escore do CRIB foram bons indicadores para a mortalidade. O uso de corticosteróide antenatal deve ser mais difundido, visando à diminuição da mortalidade...