Sociodemographic determinants and mortality of premature newborns in a medium and low-income population in Colombia, 2017-2019. / Factores determinantes sociodemográficos y de mortalidad en recién nacidos prematuros en población de medianos y bajos ingresos en Colombia, 2017-2019

Introduction: The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective: To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods: We conducted a descriptive, cross-sectional study. We evaluated the records of Cali's Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results: From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score - five minutes after birth- lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions: We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.

Introducción: El nacimiento de bebés prematuros es un problema de salud pública con gran impacto en la morbimortalidad infantil: cerca del 40 % de las muertes de niños menores de cinco años sucede en el primer mes de vida. Objetivos: Identificar la asociación entre los factores sociodemográficos maternos, el parto prematuro y la mortalidad en recién nacidos menores de 37 semanas en Santiago de Cali, 2017-2019. Materiales y métodos: Se hizo un estudio descriptivo transversal. Se evaluaron los registros de la Secretaría de Salud Pública Municipal de Cali. Se calcularon las razones de probabilidad y los intervalos de confianza (95 %) crudos y ajustados mediante el modelo de regresión logística, en tanto que los datos se procesaron en Stata 16 y los casos se georreferenciaron con el programa QGIS. Resultados: Entre el 2017 y el 2019, los nacimientos de bebés prematuros en Cali correspondieron al 11 %. El control prenatal deficiente aumentó 3,13 veces el riesgo de nacer con menos de 32 semanas (OR ajustado = 3,13; IC95% = 2,75-3,56) y, en madres de municipios fuera de la ciudad, 1,27 veces (OR ajustado = 1,27; IC95% = 1,15-1,41). La mortalidad fue de 4,29 por 1.000 nacidos vivos. Nacer con un peso menor de 1.000 g aumentó el riesgo de mortalidad en 3,42 veces (OR = 3,42; IC95% = 2,85-4,12) y, un puntaje Apgar menor de siete a los cinco minutos del nacimiento, en 1,55 veces (OR=1,55; IC95% = 1,23-1,96). Conclusiones: Se encontró que tener menos de tres controles prenatales, la procedencia de la madre fuera de Cali, ser afrodescendiente y el parto por cesárea, estaban asociados significativamente con la prematuridad de menos de 32 semanas. Hubo mayor mortalidad en los recién nacidos con menos de 1.000 gramos al nacer.

Sociodemographic determinants and mortality of premature newborns in a medium and low-income population in Colombia, 2017-2019 / Factores determinantes sociodemográficos y de mortalidad en recién nacidos prematuros en población de medianos y bajos ingresos en Colombia, 2017-2019

Introduction. The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective. To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods. We conducted a descriptive, cross-sectional study. We evaluated the records of Cali's Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results. From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score - five minutes after birth- lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions. We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.

Introducción. El nacimiento de bebés prematuros es un problema de salud pública con gran impacto en la morbimortalidad infantil: cerca del 40 % de las muertes de niños menores de cinco años sucede en el primer mes de vida. Objetivo. Identificar la asociación entre los factores sociodemográficos maternos, el parto prematuro y la mortalidad en recién nacidos menores de 37 semanas en Santiago de Cali, 2017-2019. Materiales y métodos. Se hizo un estudio descriptivo transversal. Se evaluaron los registros de la Secretaría de Salud Pública Municipal de Cali. Se calcularon las razones de probabilidad y los intervalos de confianza (95 %) crudos y ajustados mediante el modelo de regresión logística, en tanto que los datos se procesaron en Stata 16 y los casos se georreferenciaron con el programa QGIS. Resultados. Entre el 2017 y el 2019, los nacimientos de bebés prematuros en Cali correspondieron al 11 %. El control prenatal deficiente aumentó 3,13 veces el riesgo de nacer con menos de 32 semanas (OR ajustado = 3,13; IC95% = 2,75-3,56) y, en madres de municipios fuera de la ciudad, 1,27 veces (OR ajustado = 1,27; IC95% = 1,15-1,41). La mortalidad fue de 4,29 por 1.000 nacidos vivos. Nacer con un peso menor de 1.000 g aumentó el riesgo de mortalidad en 3,42 veces (OR = 3,42; IC95% = 2,85-4,12) y, un puntaje Apgar menor de siete a los cinco minutos del nacimiento, en 1,55 veces (OR=1,55; IC95% = 1,23-1,96). Conclusiones. Se encontró que tener menos de tres controles prenatales, la procedencia de la madre fuera de Cali, ser afrodescendiente y el parto por cesárea, estaban asociados significativamente con la prematuridad de menos de 32 semanas. Hubo mayor mortalidad en los recién nacidos con menos de 1.000 gramos al nacer.

Device-associated infections in neonatal care units in a middle-income country, 2016-2018.

OBJECTIVE: Describe the device-associated infections in the NICUs in Cali - Colombia, a middle-income country, between August 2016 to December 2018. METHODS: Observational cross-sectional study evaluating reports of device-associated infections in 10 NICUs in Cali, Colombia, between August 2016 and December 2018. Socio-demographic and microbiological data were obtained from the National Public Health surveillance system, through a specialized notification sheet. The relationship of device-associated infections with several outcomes including birth weight, microorganisms, and mortality was evaluated using OR CI95%, using the logistic regression model. Data processing was performed using the statistical program STATA 16. RESULTS: 226 device-associated infections were reported. The rate of infection with central line-associated bloodstream infections was 2.62 per 1000 days of device use and 2.32 per 1000 days for ventilator-associated pneumonia. This was higher in neonates under 1000 g; 4.59 and 4.10, respectively. 43.4% of the infections were due to gram-negative bacteria and 42.3% were due to gram-positive bacteria. Time from hospitalization to diagnosis of all device-associated infections had a median of 14 days. When compared by weight, infants with a weight lower than 1000 g had a greater chance of death (OR 3.61; 95% CI 1.53-8.49, p = 0.03). Infection by gram-negative bacteria was associated with a greater chance of dying (OR 3.06 CI 95 1.33-7.06, p = 0.008). CONCLUSIONS: These results highlight the need to maintain epidemiological surveillance processes in neonatal intensive care units, especially when medical devices are used.

Device-associated infections in neonatal care units in a middle-income country, 2016-2018

Abstract Objective: Describe the device-associated infections in the NICUs in Cali - Colombia, a middle-income country, between August 2016 to December 2018. Methods: Observational cross-sectional study evaluating reports of device-associated infections in 10 NICUs in Cali, Colombia, between August 2016 and December 2018. Socio-demographic and microbiological data were obtained from the National Public Health surveillance system, through a specialized notification sheet. The relationship of device-associated infections with several outcomes including birth weight, microorganisms, and mortality was evaluated using OR Cl95%, using the logistic regression model. Data processing was performed using the statistical program STATA 16. Results: 226 device-associated infections were reported. The rate of infection with central line-associated bloodstream infections was 2.62 per 1000 days of device use and 2.32 per 1000 days for ventilator-associated pneumonia. This was higher in neonates under 1000 g; 4.59 and 4.10, respectively. 43.4% of the infections were due to gram-negative bacteria and 42.3% were due to gram-positive bacteria. Time from hospitalization to diagnosis of all device-associated infections had a median of 14 days. When compared by weight, infants with a weight lower than 1000 g had a greater chance of death (OR 3.61; 95% CI 1.53-8.49, p = 0.03). Infection by gram-negative bacteria was associated with a greater chance of dying (OR 3.06 CI 95 1.33-7.06, p = 0.008). Conclusions: These results highlight the need to maintain epidemiological surveillance processes in neonatal intensive care units, especially when medical devices are used.

Biological and Psychosocial Factors, Risk Behaviors, and Perinatal Asphyxia in a University Hospital: Matched Case-Control Study, Cali, Colombia (2012-2014).

Introduction: Perinatal asphyxia is one of the main causes of morbidity and mortality in newborns. It generates high costs, both social and economic, and presents modifiable risk factors. Objective: To determine the biological and psychosocial factors and risk behaviors associated with the development of perinatal asphyxia (Sarnat II-III) in newborns from low socioeconomic status in a tier III university hospital in the city of Cali, Colombia. Materials and Methods: With a case and control design, 216 patients were studied (54 cases/162 controls) (1 case/3 matched controls). The cases were defined as newborns with modified or severe perinatal asphyxia (Sarnat II-III) between 2012 and 2014, with gestational age ≥ 36 weeks, with neurological signs not attributable to other causes, multiorgan compromise, advanced reanimation, and presence of a sentinel event. For the analysis, conditional logistic regression models were developed to evaluate association (OR), considering that the cases and controls had been paired by the birth and gestational age variables. Results: The final model showed that, from the group of biological variables, meconium amniotic fluid was identified as a risk factor (OR 15.28, 95%CI 2.78-83.94). Induction of labor lowered the risk of perinatal asphyxia by 97% (OR 0.03, 95%CI 0.01-0.21), and monitoring of fetal heart rate was associated with lower odds by 99% (OR 0.01, 95%CI 0.00-0.31) of developing perinatal asphyxia in the newborn. Regarding social variables, the lack of social support was identified as a risk factor for the development of perinatal asphyxia (OR 6.44, 95%CI 1.16-35.66); in contrast, secondary education lowered the odds of developing perinatal asphyxia by 85% when compared with pregnant women who only had primary school education (OR 0.15, 95%CI 0.03-0.77). Conclusion: Assessment of biological and psychosocial factors and social support is important in pregnant women to determine the risk of developing perinatal asphyxia in a low-income population.

Clinical Results of the Implementation of a Breast Milk Bank in Premature Infants (under 37 Weeks) at the Hospital Universitario del Valle 2018-2020.

Breast milk is widely recognized as the best source of nutrition for both full term and premature babies. We aimed to identify clinical results of the implementation of a breast milk bank for premature infants under 37 weeks in a level III hospital. 722 neonates under 37 weeks, hospitalized in the Neonatal intensive care unit (ICU), who received human breast milk from the institution's milk bank 57% (n = 412) vs. mixed or artificial 32% (n = 229), at day 7 of life. An exploratory data analysis was carried out. Measures of central tendency and dispersion were used, strength of association of odds ratio (OR) and its confidence intervals (95% confidence interval (CI)). 88.5% had already received human milk before day 7 of life. Those who received human milk, due to their clinical condition, had 4 times a greater chance of being intubated (OR 4.05; 95% CI 1.80-9.11). Starting before day 7 of life decreases the opportunity to develop necrotizing enterocolitis by 82% (adjusted odds ratio (ORa) 0.18; 95% CI 0.03-0.97), intraventricular hemorrhage by 85% (ORa 0.15; 95% CI 0.06-0.45) and sepsis by 77% (ORa 0.23; 95% CI 0.15-0.33). Receiving human milk reduces the probability of complications related to prematurity, evidencing the importance that breast milk banks play in clinical practice.

Prevalence of goiter and iodine deficiency in indigenous pregnant women from five nonmetropolitan areas of Colombia 2019 / [Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019].

Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.

Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019 / Prevalence of goiter and iodine deficiency in indigenous pregnant women from five non-metropolitan areas of Colombia 2019

RESUMEN Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.

ABSTRACT Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

Factors Associated With Late Prematurity in the University Hospital of Valle Cali, Colombia During 2013-2014.

Introduction: The birth rate of late premature babies has been increasing in recent years, composing now 75% of all premature births. This growing trend can be explained by different demographic transformations such as an increase in the demand for infertility treatments, older maternal age and the higher incidence of multiple pregnancies, cesarean sections, and labor induction. These premature babies contribute 30% to the global neonatal mortality rate. Objective: To identify the factors associated with late prematurity at the Hospital Universitario del Valle during the years 2013-2014. Methodology: Case and control design, 424 patients, 212 cases and 212 controls participated. Cases were defined as newborns with gestational age between 34 and 36 weeks and 6 days old. For the analysis, logistic regression models were developed and association forces (OR) were determined. Results: A univariate analysis shows that the proportion of teenage pregnant women corresponds to 22.64%. Bivariate analysis shows the maternal morbidity due to hypertensive disorders was 1.6 times higher (95% CI 1.06-2.63), the obstetric alterations in 2.9 times (CI of 95% 1.56-5.44), late preterm infants require more oxygen support 3.26 times (95% CI 1.76-6.03). After adjusting the model, it was found that late premature infants have a 3-fold probability of requiring some resuscitation maneuver (ORa 3.23 95% CI 2.09-4.99), birth is higher by cesarean section by 4.17 times (ORa 4.17 IC 95% 2.50-6.98), maternal morbidity was higher in 1.37 times (ORa 1.37 95% CI 1.14-1.65). The morbidity of the newborn was greater, close to the statistical significance for late premature infants in 1.26 times (ORa 1.26 95% CI 0.97-1.64). Conclusions: Late premature births in this study show a higher probability of developing morbidity, have a greater opportunity to be born by cesarean section, are products of mothers with morbidity (specifically hypertensive disorders), and require further resuscitation with a need of early obstetric intervention.

La pulsioximetría como herramienta para la tamización de cardiopatías congénitas críticas. Una revisión narrativa / Pulse oximetry as a screening tool for critical congenital heart diseases. A narrative review

Resumen Objetivo: Revisar el concepto de cardiopatía congénita crítica, describir el proceso de consolidación de la pulsioximetría como herramienta para su tamización y llamar la atención sobre la necesidad de implementarla en países de bajos ingresos como Colombia. Métodos: Se hizo una búsqueda en las bases de datos PubMed-MEDLINE y Scholar Google, usando los términos MeSH: "CongenitalAbnormalities", "HeartDefects, Congenital" "Oximetry" y "Neonatal Screening", cruzando el término "HeartDefects, Congenital" con los demás, por medio del operador booleano AND. Se incluyeron publicaciones desde 1992 y no se excluyeron artículos por metodología o idioma. Resultados: El 25% de los casos de recién nacidos vivos con cardiopatía congénita son críticos y la pulsioximetría es una alternativa efectiva para su reconocimiento temprano. Se hizo una revisión sobre el tema, mencionando los estudios con los mayores tamaños de muestra que han permitido la consolidación de la pulsioximetría como herramienta para tamización de cardiopatías congénitas críticas, describiendo el abordaje estadounidense al respecto y llamando la atención sobre la necesidad de implementar dicha tamización en Colombia. Conclusiones: Existe evidencia para la introducción de la pulsioximetría como prueba de tamización para defectos cardiacos congénitos críticos. En Colombia no se han presentado iniciativas oficiales para generalizar la práctica.

Abstract Objective: This article sets out to review the concept of critical congenital heart diseases, as well as to describe the consolidation process with pulse oximetry as a tool for their screening, and to call attention to the need to implement this in low income countries like Colombia. Methods: A search was made in the PubMed-MEDLINE and Google Scholar databases using the MeSH terms: "Congenital Abnormalities", "Heart Defects, Congenital'" "Oximetry" and "Neonatal Screening", crossing the term "Heart Defects, Congenital" with the rest, by means of the Boolean operator AND. Publications since 1992 were included and article were not excluded due to methodology or language. Results: Around one-quarter (25%) of live newborns with a congenital heart disease are critical, and pulse oximetry is an effective alternative for its early recognition. A review was carried out on the subject, mentioning studies with large sample sizes that have allowed the consolidation of pulse oximetry as screening tool for critical congenital heart diseases. The approach used in the USA in this respect is described, as well as calling attention to the need to implement this screening method in Colombia. Conclusions: There is evidence for the introduction of pulse oximetry as a screening test for critical congenital heart disease defects. No official initiatives have been presented in Colombia to generalise the practice.

[Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011].

INTRODUCTION: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. OBJECTIVE: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. MATERIALS AND METHODS: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. RESULTS: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. CONCLUSIONS: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011 / Factores de riesgo asociados con el desarrollo de asfixia perinatal en neonatos en el Hospital Universitario del Valle, Cali, Colombia, 2010-2011

Abstract Introduction: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. Objective: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Materials and methods: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Results: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Conclusions: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Resumen Introducción: La asfixia perinatal constituye una de las principales causas de morbilidad y mortalidad perinatal en el mundo, tiene factores de riesgo modificables y genera altos costos para los sistemas de salud. Objetivo: Determinar los factores de riesgo asociados al desarrollo de asfixia perinatal en recién nacidos en el Hospital Universitario del Valle, Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio de casos incidentes y controles concurrentes. Los casos se definieron como neonatos con asfixia perinatal moderada a grave, de edad de gestación mayor o igual a 36 semanas, que requirieron reanimación avanzada y presentaron, al menos, una de las siguientes condiciones: alteraciones neurológicas tempranas, falla orgánica múltiple o aparición de un evento centinela. Los controles se definieron como neonatos sin diagnóstico de asfixia, nacidos hasta con una semana de diferencia con respecto al caso y de edad de gestación comparable. Se excluyeron los pacientes con malformaciones congénitas mayores y síndromes. Resultados: Se estudiaron 56 casos y 168 controles. El desprendimiento prematuro de la placenta (odds ratio, OR=41,09; IC95% 4,61-366,56), un trabajo de parto con fase expulsiva prolongada (OR=31,76; IC95% 8,33-121,19), no usar oxitocina (OR=2,57; IC95% 1,08-6,13) y ser madre soltera (OR=2,56; IC95% 1,21-5,41) fueron factores de riesgo para el desarrollo de asfixia perinatal en la población bajo estudio. En las madres de los casos se encontraron dificultades sociales en mayor proporción. Conclusiones: Se recomienda un control adecuado y una vigilancia apropiada del trabajo de parto, hacer un estricto partograma, y una búsqueda activa, de manera que cada mujer embarazada tenga un adecuado control prenatal y reciba apoyo social.