Morbidity and mortality due to surgical congenital malformations from the perspective of surgical neonatal ICU outside a maternity service: a retrospective cohort study.

OBJECTIVE: To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. METHODS: A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. RESULTS: During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). CONCLUSION: The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture.

Morbidity and mortality due to surgical congenital malformations from the perspective of surgical neonatal ICU outside a maternity service: a retrospective cohort study

SUMMARY OBJECTIVE: To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. METHODS: A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. RESULTS: During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). CONCLUSION: The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture

RESUMO OBJETIVO: Traçar o perfil de pacientes atendidos em uma Unidade de Terapia Intensiva Neonatal cirúrgica nível III desvinculada de maternidade e analisar fatores de risco para mortalidade nesta população. MÉTODOS: estudo de coorte retrospectivo, avaliando os pacientes internados em um serviço de Unidade de Terapia Intensiva Neonatal cirúrgica nível III de referência no estado no período de junho/2015 a novembro/2017. A análise univariada foi realizada pelo teste de Qui-quadrado e T-student ou Mann-Whitney. Foi realizada a analise multivariada por regressão logística incluindo no modelo as variáveis que apresentaram valor de P <0,2 na analise univariada. Foi realizada curva de Kaplan-Meier e teste Log-Rank com as varáveis que foram estatisticamente associadas ao óbito na análise multivariada. Adotou-se um nível de significância de a=5% e um erro B=80%. RESULTADOS: Neste período, 246 pacientes foram internados neste serviço. Foram a óbito 58 (23,8%) pacientes, com tempo médio de óbito de 18 dias. Metade dos pacientes apresentaram diagnóstico clínico de sepse (50,6%), com hemocultura foi positiva em 25,2% e bactérias gram-positivas (48,4%) foram os principais patógenos isolados. As variáveis que se mantiveram no modelo final após a análise multivariada foram diagnóstico de cardiopatia congênita (OR=4,5; p=0,016), diagnóstico clinico de sepse (OR=8,1; p=0,000), e isolamento de bactéria gram-positiva na hemocultura (OR=3,9; p=0,006). CONCLUSÃO: O serviço de Unidade de Terapia Intensiva cirúrgica nível III não vinculada a maternidade apresenta perfil diferenciado de morbimortalidade, e o óbito esteve associado ao diagnóstico de cardiopatia congênita, ao diagnostico clinico de sepse e ao isolamento de bactérias gram-positivas na hemocultura.