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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
2.
N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328

RESUMO

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia
3.
N C Med J ; 81(1): 28-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908329

RESUMO

This commentary evaluates access and barriers to perinatal care in North Carolina utilizing key goals the state has identified in its strategic plans, such as expanding health care access for North Carolinians, increasing access to preconception care for women and men, improving access to prenatal care, and undoing racism.


Assuntos
Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Assistência Perinatal , Qualidade da Assistência à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , North Carolina/epidemiologia , Gravidez
5.
RECIIS (Online) ; 13(4): 843-853, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047584

RESUMO

Os indicadores de morbidade e de mortalidade materno-infantis são essenciais no contexto da organização da Rede Cegonha, no âmbito do Sistema Único de Saúde (SUS). Esta rede organiza-se para assegurar o acesso, o acolhimento e a resolutividade, por meio de um modelo de atenção voltado para o pré-natal, parto e nascimento, puerpério e sistema logístico. Este artigo apresenta um estudo ecológico desta rede em uma Regional de Saúde, realizado com uso de dados dos Sistemas de Informação de Saúde do Departamento de Informática do SUS. Verificou-se um percentual crescente de gestantes que realizaram sete ou mais consultas pré-natais. No entanto, poucas concluíram a assistência pré-natal, porque não realizaram a consulta de puerpério. Observou-se uma taxa de mortalidade infantil próxima à da meta estipulada pela ONU. Identificou-se um aumento das cesáreas e uma redução de partos normais, além de uma alta mortalidade materna. Esses indicadores apontam para a necessidade de melhoria da qualidade da atenção pré-natal e da assistência ao parto.


Indicators of maternal-child morbidity and mortality are essential in the context of the organization of the Rede Cegonha (Stork Network), within the scope of the Unified Health System (SUS ­ Sistema Único de Saúde). This network is organized to ensure access, protection and successful resolution, through a model of attention focused on prenatal, delivery and childbirth, puerperium (or postpartum period) and logistic system. This article presents an ecological study of this network in a Regional de Saúde (Regional Health Department) that was carried out using data from the SUS Department of Informatics of the Health Information Systems. An increasing percentage of pregnant women who had seven or more prenatal visitscould be observed. However, few pregnant women completed prenatal care because they have not sought for the puerperium consultation. A child mortality rate close to the target set out in the United Nations Sustainable Development Goals was observed. An increase in caesarean sections and a reduction in normal deliveries and at the same time a high maternal mortality were identified. These indicators point to the need to improve the quality of prenatal and delivery care.


Los indicadores de morbilidad y de mortalidad materno-infantil son esenciales en el contexto de la organización de la Rede Cegonha (Red Cigüeña), en el ámbito del Sistema Único de Salud (SUS ­ Sistema Único de Saúde). Esa red se organiza para asegurar el acceso, el acogimiento y la capacidad resolutiva, por medio de un modelo de atención dirigido al prenatal, parto, nacimiento, puerperio y sistema logístico. Este artículo presenta un estudio ecológico de la red en una Regional de Saúde (Dirección Regional de Salud) realizado utilizando datos de los Sistemas de Información de Salud del Departamento de Informática del SUS. Se ha verificado un porcentaje creciente de gestantes que realizaron siete o más consultas de prenatal. Sin embargo, pocas gestantes concluyeron la asistencia prenatal, porque no realizaron la consulta de puerperio. Se observó una tasa de mortalidad infantil próxima a la meta estipulada por la ONU. Se identificó un aumento de las cesáreas y una reducción de partos normales, además de una alta mortalidad materna. Esos indicadores apuntan la necesidad de mejorar la calidad de la atención prenatal y de la asistencia al parto.


Assuntos
Humanos , Mortalidade Infantil , Mortalidade Materna , Indicadores Básicos de Saúde , Saúde da Mulher , Assistência à Saúde , Cuidado Pré-Natal , Sistema Único de Saúde , Saúde da Criança , Parto Humanizado , Serviços de Saúde Materno-Infantil , Estudos Ecológicos , Acolhimento , Acesso aos Serviços de Saúde
6.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46891

RESUMO

Plataforma com dados indicadores sobre a mortalidade neonatal de 2000 a 2015. Agenda 2030 - objetivo 3 - Saúde e bem estar


Assuntos
Mortalidade Infantil/etnologia , Brasil/etnologia , Desenvolvimento Sustentável
7.
BMJ ; 367: l6131, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748223

RESUMO

OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN: Multicentre, open label, randomised controlled superiority trial. SETTING: 14 hospitals in Sweden, 2016-18. PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.


Assuntos
Idade Gestacional , Doenças do Recém-Nascido , Trabalho de Parto Induzido , Conduta Expectante/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Análise de Intenção de Tratamento , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Natimorto/epidemiologia , Suécia/epidemiologia , Nascimento a Termo
8.
Medicine (Baltimore) ; 98(44): e17751, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689830

RESUMO

Maternal bacterial sepsis during pregnancy and the postpartum period is a common cause of maternal mortality and fetal morbidity and mortality. This study was performed to analyze perinatal prognosis and related factors of maternal bacterial sepsis in west China.We conducted a cross-sectional study of pregnant women with bacterial sepsis who were admitted into a tertiary care center in western China between 2011and 2015. Data from these cases were collected and analyzed.Eighty six women were identified with bacterial sepsis in our hospital, and the incidence of maternal bacterial sepsis was 1.7 per 1000 maternities, the incidence of septic shock was 1.8 per 10,000 maternities, and 1 maternal death occurred. Among the 86 pregnant women with bacterial sepsis, genital tract infection was the most common source of infection (41/86, 47.7%). The most common bacteria in the Gram-positive bacteria group was Listeria monocytogenes and in the Gram-negative bacteria group was Escherichia coli. The premature delivery rate (65.7%) was substantially higher in the Gram-negative bacteria group (P = .011), and the miscarriage rate (31.3%) was higher in the Gram-positive bacteria group (P = .042). The fetal/neonatal mortality rate was 20% (21/105) and higher in the Gram-positive bacteria group (P = .008), and the infant mortality rate in 1 year was 7.1% (6/84).Bacterial sepsis remains an alarming cause of both maternal and fetal morbidity and mortality, and infant mortality. Key treatment involves a multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women with sepsis and early initiation of appropriate antibiotics according to the type of bacterial infection. The effect of maternal sepsis on long-term fetal outcome should be investigated.


Assuntos
Bactérias Gram-Negativas , Bactérias Gram-Positivas , Complicações Infecciosas na Gravidez/mortalidade , Infecções do Sistema Genital/mortalidade , Sepse/mortalidade , Aborto Espontâneo/microbiologia , Aborto Espontâneo/mortalidade , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Infecções do Sistema Genital/microbiologia , Sepse/microbiologia
9.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
10.
12.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593288

RESUMO

Late and moderately preterm infants, born between 32+0/7 and 36+6/7 gestational weeks, comprise more than 80 % of all preterm infants and account for almost 40 % of all days of neonatal care. While their total number of days of care has not changed, an increasing part of their neonatal stay (from 29 % in 2011 to 41 % in 2017) is now within home care programmes. Late and moderate preterm birth is often complicated by respiratory disorders, hyperbilirubinemia, hypothermia and feeding difficulties. These infants also have an increased risk of perinatal death and neurologic complications. In the long run, they have higher risks of cognitive impairment, neuropsychiatric diagnoses and need for asthma medication. As young adults, they have a lower educational level and a lower average salary than their full-term counterparts. They also have an increased risk of long-term sick leave, disability pension and need for economic assistance from society.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Cognitivos/epidemiologia , Educação Especial/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Nascimento Prematuro/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de Risco , Tempo
14.
N Engl J Med ; 381(14): 1333-1346, 2019 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-31577875

RESUMO

BACKGROUND: The safety, efficacy, and appropriate timing of isoniazid therapy to prevent tuberculosis in pregnant women with human immunodeficiency virus (HIV) infection who are receiving antiretroviral therapy are unknown. METHODS: In this multicenter, double-blind, placebo-controlled, noninferiority trial, we randomly assigned pregnant women with HIV infection to receive isoniazid preventive therapy for 28 weeks, initiated either during pregnancy (immediate group) or at week 12 after delivery (deferred group). Mothers and infants were followed through week 48 after delivery. The primary outcome was a composite of treatment-related maternal adverse events of grade 3 or higher or permanent discontinuation of the trial regimen because of toxic effects. The noninferiority margin was an upper boundary of the 95% confidence interval for the between-group difference in the rate of the primary outcome of less than 5 events per 100 person-years. RESULTS: A total of 956 women were enrolled. A primary outcome event occurred in 72 of 477 women (15.1%) in the immediate group and in 73 of 479 (15.2%) in the deferred group (incidence rate, 15.03 and 14.93 events per 100 person-years, respectively; rate difference, 0.10; 95% confidence interval [CI], -4.77 to 4.98, which met the criterion for noninferiority). Two women in the immediate group and 4 women in the deferred group died (incidence rate, 0.40 and 0.78 per 100 person-years, respectively; rate difference, -0.39; 95% CI, -1.33 to 0.56); all deaths occurred during the postpartum period, and 4 were from liver failure (2 of the women who died from liver failure had received isoniazid [1 in each group]). Tuberculosis developed in 6 women (3 in each group); the incidence rate was 0.60 per 100 person-years in the immediate group and 0.59 per 100 person-years in the deferred group (rate difference, 0.01; 95% CI, -0.94 to 0.96). There was a higher incidence in the immediate group than in the deferred group of an event included in the composite adverse pregnancy outcome (stillbirth or spontaneous abortion, low birth weight in an infant, preterm delivery, or congenital anomalies in an infant) (23.6% vs. 17.0%; difference, 6.7 percentage points; 95% CI, 0.8 to 11.9). CONCLUSIONS: The risks associated with initiation of isoniazid preventive therapy during pregnancy appeared to be greater than those associated with initiation of therapy during the postpartum period. (Funded by the National Institutes of Health; IMPAACT P1078 TB APPRISE ClinicalTrials.gov number, NCT01494038.).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Isoniazida/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Tuberculose/prevenção & controle , Adolescente , Adulto , Antituberculosos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Isoniazida/efeitos adversos , Testes de Função Hepática , Período Pós-Parto , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Adulto Jovem
15.
Afr Health Sci ; 19(2): 1924-1929, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656475

RESUMO

Background: Neanatal comploications are the commonest problems facing babies in Tanzania. An attempt has been made to investigate determinants of neonatal outcomes among postnatal women. Methods: Using a case-contrrol study design, 165 women were selected from 3 health facilities, where they had had antenatal care (ANC), labour, delivery and post natal care. Results: Chi- square test revealed that gestational age (p-value, 0.01), HIV status (p-value, 0.000) and malaria (p-value, 0.001<0.05) were significantly associated with adverse neonatal outcomes. Conclusion: The study concluded that implementation of community-based intervention is needed to ensure survival of newborns.


Assuntos
Infecções por HIV/epidemiologia , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Adolescente , Adulto , Anemia/epidemiologia , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Transmissão Vertical de Doença Infecciosa , Malária/epidemiologia , Idade Materna , Paridade , Cuidado Pós-Natal/organização & administração , Gravidez , Adulto Jovem
16.
Prensa méd. argent ; 105(9 especial): 563-570, oct 2019. tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1046604

RESUMO

Mothers increasingly mention poor health of the newborn child as the reason for abandoning the child. One of the factors causing the unsatisfactory state of the child's health is the child's premature birth, a little or long before the due date. According to the data of most developed countries of the world, from 5% to 10% of children in the general population are born prematurely. In the Russian Federation, these premature births amount for around 75% of infant mortality. Moreover, the most vulnerable ones among premature infants are children with extremely low and very low body weight. In this regard, the goal of the study has been formulated to assess the state of health of the children born with very low and extremely low body weight and left without parental care. Material and Methods. For this, a retrospective analysis of the labor and delivery records has been conducted for 182 newborns abandoned by mothers in maternity hospitals in the Chelyabinsk region in the period from 2012 to 2017. Results and discussion. Over the study period, the average proportion of newborns with low and extremely low body weight was as follows: 12.1% in the big urban center, 12.0% in urban districts and 12.7% in rural municipalities of the total number of early social orphans. The proportion of newborns with very low body weight was 69.0%; 31.0% had extremely low body weight. The smallest of the examined infants was a newborn with a birth weight of 840 grams. It was found that children born with extremely low and very low body weight had from two to three pathologies already at birth. Conclusion. The identified risk factors for the birth of premature babies are the following: extragenital diseases of the mother, complicated obstetric and gynecological history, infectious diseases of the mother. A high proportion of newborns with very low and extremely low body weight (12.0-12.7%) among abandoned children indicates that the latter are at risk for this pathology.


Assuntos
Cuidado Pós-Natal , Recém-Nascido Prematuro , Criança Abandonada , Mortalidade Infantil , Estudos Retrospectivos , Fatores de Risco , Recém-Nascido de Peso Extremamente Baixo ao Nascer
17.
Rev. Ciênc. Plur ; 5(2): 16-31, ago. 2019. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1021746

RESUMO

Introdução:A Mortalidade Neonatal (MN) é o principal componente dos índices de Mortalidade Infantil (MI) representando no primeiro ano de vida, mais de 70% dos óbitos, com principal ocorrência entre os neonatais precoces.Objetivo:A presente pesquisa tem como objetivo delinear o Perfil da Mortalidade Neonatal no Estado de Alagoas, durante o período de 2008 a 2017. Método:Trata-se de um estudo descritivo, com abordagens quantitativas, do tipo retrospectivas, utilizando dados secundários disponibilizados pelo Setor de Vigilância de Óbitos da Secretária de Saúde do Estado de Alagoas (SESAU). Os dados selecionados foram referentes aos registros de óbitos neonatais ocorridos entre 0 a 28 dias incompletos de vida, registrados em Alagoas no período de 2008 a 2017. Para realização distribuições proporcionais foi utilizado o programa estatístico BioEstat versão 5.3. Resultadose Discussões:Os resultados revelaram no período do estudo 5.647 óbitos neonatais em Alagoas. Destes (12,6%) registrados em 2018. Sendo (55,6%) no sexo masculino, (25,5%) com peso entre 501 g<1kg, (77,5%) entre idade menor que 7 dias de vida, e como causa principal o Desconforto Respiratório do recém-nascido (19,6%).Conclusões:O conhecimento das características da Mortalidade Neonatal no Estado de Alagoas, contribui para a eliminação dos riscos e o alcance de uma assistência à saúde com equidade, possibilitando a formulação de ações que promovam a melhoria da assistência prestada ao neonato, reduzindo assim as Taxas de Mortalidade (AU).


Introduction:Neonatal Mortality (NM) isthe main component of Infant Mortality Indexes (IM), representing, in the first year of life, more than 70% of deaths, with a higher occurrence among early neonates.Objective:This study aims to delineate the Profile of Neonatal Mortality in the State of Alagoas, from 2008 to 2017. Methods:This is a descriptive study, with quantitative approaches, of the retrospective type, using secondary data provided by the Sector of Sanitary Surveillance of the Health Department of the State of Alagoas (SESAU). The selected data were related to the records of neonatal deaths occurred between 0 and 28 days of incomplete life, registered in Alagoas from 2008 to 2017. To perform proportional distributions, the statistical program BioEstat version 5.3 was used.Results:The results revealed in the study period 5,647 neonatal deaths in Alagoas. Of these (12.6%) registered in 2018. Being male (55.6%), (25.5%) with weight between 501g <1 kg, (77.5%)among children under 7 days, and the main cause of respiratorydiscomfort the newborn (19.6%).Conclusions:The knowledge of the characteristics of Neonatal Mortality in the State of Alagoas contributes to the elimination of risks and the reach of health care with equity, enabling the formulation of actions that promote the improvement of the care given to the newborn, reducing the rates of Mortality (AU).


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Perfil de Saúde , Brasil , Mortalidade Infantil , Mortalidade , Condições Sociais , Epidemiologia Descritiva
18.
Cochrane Database Syst Rev ; 9: CD013201, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31549743

RESUMO

BACKGROUND: Germinal matrix-intraventricular haemorrhage (GMH-IVH) remains a substantial issue in neonatal intensive care units worldwide. Current therapies to prevent or treat GMH-IVH are limited. Stem cell-based therapies offer a potential therapeutic approach to repair, restore, and/or regenerate injured brain tissue. These preclinical findings have now culminated in ongoing human neonatal studies. OBJECTIVES: To determine the benefits and harms of stem cell-based interventions for prevention or treatment of germinal matrix-intraventricular haemorrhage (GM-IVH) in preterm infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1), in the Cochrane Library; MEDLINE via PubMed (1966 to 7 January 2019); Embase (1980 to 7 January 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 7 January 2019). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: We attempted to identify randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing (1) stem cell-based interventions versus control; (2) mesenchymal stromal cells (MSCs) of type or source versus MSCs of other type or source; (3) stem cell-based interventions other than MSCs of type or source versus stem cell-based interventions other than MSCs of other type or source; or (4) MSCs versus stem cell-based interventions other than MSCs. For prevention studies, we included extremely preterm infants (less than 28 weeks' gestation), 24 hours of age or less, without ultrasound diagnosis of GM-IVH; for treatment studies, we included preterm infants (less than 37 weeks' gestation), of any postnatal age, with ultrasound diagnosis of GM-IVH. DATA COLLECTION AND ANALYSIS: For each of the included trials, two review authors independently planned to extract data (e.g. number of participants, birth weight, gestational age, type and source of MSCs, other stem cell-based interventions) and assess the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). Primary outcomes considered in this review are all-cause neonatal mortality, major neurodevelopmental disability, GM-IVH, and extension of pre-existing non-severe GM-IVH. We planned to use the GRADE approach to assess the quality of evidence. MAIN RESULTS: Our search strategy yielded 769 references. We did not find any completed studies for inclusion. One randomised controlled trial is currently registered and ongoing. Five phase 1 trials are described in the excluded studies. AUTHORS' CONCLUSIONS: Currently no evidence is available to show the benefits or harms of stem cell-based interventions for treatment or prevention of GM-IVH in preterm infants.


Assuntos
Hemorragia Cerebral/prevenção & controle , Circulação Cerebrovascular/fisiologia , Mortalidade Infantil , Lactente Extremamente Prematuro , Doenças do Prematuro/prevenção & controle , Células-Tronco , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Prematuro/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Lakartidningen ; 1162019 09 09.
Artigo em Sueco | MEDLINE | ID: mdl-31503320

RESUMO

In South Asia, maternal and child undernutrition is common with consequences for short- and long-term health. In the MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab) in Bangladesh 4436 pregnant women were allocated to early or later start of food supplements and different micronutrient alternatives. Children of mothers who received food supplementation from week 9 combined with multiple micronutrients showed a halved infant mortality rate. The early initiation of prenatal food supplementation reduced the risk of stunting up to five years and was associated with more favourable metabolic markers. The MINIMat study is run by icddr,b in Bangladesh and Uppsala University in collaboration with seven other universities. Twenty Ph.D. students have so far defended their theses and more than 100 scientific papers have been published.


Assuntos
Suplementos Nutricionais , Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição Materna , Micronutrientes/administração & dosagem , Adolescente , Adulto , Bangladesh , Biomarcadores/análise , Índice de Massa Corporal , Criança , Desenvolvimento Infantil , Pré-Escolar , Dieta , Status Econômico , Escolaridade , Feminino , Hemoglobinas/análise , Humanos , Lactente , Recém-Nascido , Paridade , Vigilância da População , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Socioeconômicos , Adulto Jovem
20.
Yonsei Med J ; 60(10): 984-991, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31538434

RESUMO

PURPOSE: Despite the increasing use of continuous renal replacement therapy (CRRT) in the neonatal intensive care unit (NICU), few studies have investigated its use in preterm infants. This study evaluated the prognosis of preterm infants after CRRT and identified risk factors of mortality after CRRT. MATERIALS AND METHODS: A retrospective review was performed in 33 preterm infants who underwent CRRT at the NICU of Samsung Medical Center between 2008 and 2017. Data of the demographic characteristics, predisposing morbidity, cardiopulmonary function, and CRRT were collected and compared between surviving and non-surviving preterm infants treated with CRRT. Univariable and multivariable analyses were performed to identify factors affecting mortality. RESULTS: Compared with the survivors, the non-survivors showed younger gestational age (29.3 vs. 33.6 weeks), lower birth weight (1359 vs. 2174 g), and lower Apgar scores at 1 minute (4.4 vs. 6.6) and 5 minutes (6.5 vs. 8.6). At the initiation of CRRT, the non-survivors showed a higher incidence of inotropic use (93% vs. 40%, p=0.017) and fluid overload (16.8% vs. 4.0%, p=0.031). Multivariable analysis revealed that fluid overload >10% at CRRT initiation was the primary determinant of mortality after CRRT in premature infants, with an adjusted odds ratio of 14.6 and a 95% confidence interval of 1.10-211.29. CONCLUSION: Our data suggest that the degree of immaturity, cardiopulmonary instability, and fluid overload affect the prognosis of preterm infants after CRRT. Preventing fluid overload and earlier initiation of CRRT may improve treatment outcomes.


Assuntos
Recém-Nascido Prematuro/fisiologia , Terapia de Substituição Renal , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Análise Multivariada , Terapia de Substituição Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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