Early death, morbidity and pharmacotherapy in extremely premature and very premature in neonatal intensive care units / Morte precoce, morbidade e farmacoterapia em prematuros extremos e muito prematuros em unidades de terapia intensiva neonatal

Abstract Objectives: to evaluate the evolution of extremely preterm and very preterm infants admitted to neonatal intensive care units, regarding the use of ventilatory support, morbidities, medication use, death, survival and viability. Methods: a non-concurrent cohort study, with 163 very premature and extreme newborns hospitalized in three neonatal intensive care units, during 2016 and 2017. A descriptive analysis of the data obtained from the medical records was performed. The outcomes studied were the use of ventilatory support, morbidities, medication use, death and causes of death. A survival curve was constructed and a viability limit was defined. Results: in the study, 28.2% were extreme and 71.8% were very premature. In this order of subgroups, the need for mechanical ventilation was higher for the extremes (65.2% and 41.0%) and the main diagnosis was early sepsis (78.6% and 82.6). Off-label (60.5% and 47.9%) and off-license (25.3% and 29.0%) medications were used. Most deaths (57.8%) occurred between the extremes, mainly due to septic shock. Survival was lower for the lowest gestational ages and the limit of viability was between 26 and 27 weeks. Conclusions: the main morbidities were from the respiratory system, with high use of off-label and unlicensed medications. Extremes had a greater demand for intensive care in addition to needing more drugs and progressing more to death.

Resumo Objetivos: avaliar a evolução dos prematuros extremos e muito prematuros internados em unidades de terapia intensiva neonatais, quanto ao uso de suporte ventilatório e de medicamentos, óbito, sobrevida e viabilidade. Métodos: estudo de coorte não concorrente, com 163 recém-nascidos muito prematuros e extremos internados em três unidades de terapia intensiva neonatais, durante 2016 e 2017. Realizou-se análise descritiva dos dados obtidos dos prontuários. Os desfechos estudados foram o uso de suporte ventilatório, morbidades, uso de medicamentos, óbito e causas de óbito. Foi construída curva de sobrevivência e delimitado um limite de viabilidade. Resultados: no estudo, 28,2% eram extremos e 71,8% muito prematuros. Nessa ordem de subgrupos, a necessidade de ventilação mecânica foi maior para os extremos (65,2% e 41,0%) e o principal diagnóstico foi sepse precoce (78,6% e 82,6).Medicamentos off-label (60,5% e 47,9%) e sem-licença (25,3% e 29,0%) foramutilizados. A maioria dos óbitos (57,8%) ocorreu entre os extremos, principalmente por choque séptico. A sobrevivência foi menor para as menores idades gestacionais e o limite de viabilidade ficou entre 26 e 27 semanas. Conclusões: as principais morbidades foram do sistema respiratório, com alto uso de medicamentos off-label e sem licença. Extremos tiveram maior demanda de cuidados intensivos além de necessitarem de mais medicamentos e evoluírem mais ao óbito.

Série Histórica de Mortalidade por Neoplasias no Estado da Bahia entre os Anos de 2008 e 2018 / Time Series of Mortality from Neoplasms in the State of Bahia between 2008 and 2018 / Serie Histórica de Mortalidad por Neoplasias en el Estado de Bahía entre los Años 2008 y 2018

Introdução: A mortalidade por neoplasias no Brasil se distribui de forma distinta entre as Macrorregiões, sendo a Nordeste responsável pelo segundo maior número de óbitos por neoplasias e, nessa Região, a Bahia ocupa a primeira posição. Objetivo: Analisar a tendência da mortalidade por neoplasias no Estado da Bahia e nas nove Macrorregiões de Saúde, entre 2008 e 2018. Método: Estudo ecológico, a partir dos óbitos por neoplasia (C00-D48) nessas Macrorregiões, registrados no Sistema de Informações sobre Mortalidade entre 2008 e 2018. As tendências de mortalidade por faixa etária foram analisadas pela regressão Joinpoint, tendo como desfecho morte por câncer e ano do óbito como variável independente. Resultados: Ocorreram 115.034 óbitos relacionados à neoplasia, sendo 39,2% registrados na Macrorregião Leste, 53,2% em homens, 65,4% na faixa etária de 60 anos ou mais, 24% com 1 a 3 anos de escolaridade, 68,6% eram negros e 50,9% eram não casados. As tendências das taxas de mortalidade por 100 mil habitantes, ajustadas para as faixas etárias de maiores e menores de 60 anos, indicaram que houve aumento dos óbitos em todas as Macrorregiões, entretanto, o incremento foi maior na Macrorregião Norte para maiores de 60 anos e na Macrorregião Oeste para menores de 60 anos. Conclusão: A mortalidade por câncer nas Macrorregiões baianas aumentou em ambas as faixas etárias, porém há diferenças no perfil de mortalidade por câncer entre as Macrorregiões de um mesmo Estado, indicando a necessidade de criação de políticas que levem em consideração essas peculiaridades regionais

Introduction: Mortality by neoplasms in Brazil is distributed differently among the Macroregions, with the Northeast responsible for the second highest number of deaths and, within this Macroregion, Bahia is ranked first. Objective: To analyze the trend of mortality by neoplasms in the State of Bahia and in the nine health Macroregions, between 2008 and 2018. Method: Ecological study based on deaths by neoplasia (C00-D48) in these Macroregions and registered in the Mortality Information System between 2008 and 2018. Mortality trends by age group were analyzed using the Joinpoint regression, with cancer death as an outcome and year of death as an independent variable. Results: There were 115,034 deaths related to neoplasia, 39.2% of which were recorded in the East Macroregion, 53.2% in men, 65.4% in the age group of 60 years or more, 24% with 1 to 3 years of education, 68.6% were black and 50.9% were not married. Trends in mortality rates per 100,000 inhabitants adjusted for the age groups of older and younger than 60 years indicated that the number of deaths grew in all Macroregions, however the increase was greater in the North Macroregion for over 60 and in the West Macroregion for under 60 years old. Conclusion: Cancer mortality in Bahia Macroregions has increased for both age groups, but there are differences in the profile of cancer mortality among Macroregions in the same state, indicating the need to create policies that address these regional peculiarities

Introducción: La mortalidad por neoplasias en Brasil se distribuye de manera diferente entre las Macrorregiones, siendo la Nordeste responsable del segundo mayor número de muertes por neoplasias y, dentro de esta Macrorregión, Bahía ocupa el primer lugar. Objetivo: Analizar la tendencia de la mortalidad por neoplasias en el Estado de Bahía y en las nueve Macrorregiones de salud, entre 2008 y 2018. Método: Estudio ecológico con base en las muertes por neoplasias (C00-D48) ocurridas en las Macrorregiones de Bahía y registrados en el Sistema de Información de Mortalidad entre 2008 y 2018. Las tendencias de mortalidad por grupo de edad se analizaron mediante la regresión de Joinpoint, con muerte por cáncer como resultado y año de muerte como variable independiente. Resultados: Se registraron 115.034 defunciones relacionadas con neoplasias, de las cuales 39,2% se registraron en la Macrorregión Este, 53,2% en hombres, 65,4% en el grupo de edad de 60 años o más, 24% con 1 a 3 años de escolaridad, 68,6% eran negros y 50,9% no estaban casados. Las tendencias en las tasas de mortalidad por 100.000 habitantes ajustadas por los grupos de edad mayores y menores de 60 años indicaron que todas las Macrorregiones experimentaron un aumento en el número de muertes, sin embargo, el aumento fue mayor en la Macrorregión Norte para los mayores de 60 años y en la Macrorregión Oeste para menores de 60 años. Conclusión: La mortalidad por cáncer en las Macrorregiones de Bahía ha aumentado para ambos grupos de edad, pero existen diferencias en el perfil de mortalidad por cáncer entre las Macrorregiones de un mismo Estado, lo que indica la necesidad de crear políticas que tomen en cuenta estas peculiaridades regionales

Premature birth: topics in physiology and pharmacological characteristics.

OBJECTIVE: To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice. METHODS: This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020. RESULTS: Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics. CONCLUSIONS: Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.

Premature birth: topics in physiology and pharmacological characteristics

SUMMARY OBJECTIVE: To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice. METHODS: This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020. RESULTS: Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics. CONCLUSIONS: Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.