Factors associated with neonatal near miss and death in public referral maternity hospitals / Fatores associados ao near miss e óbito neonatais em maternidade pública de referência

ABSTRACT

Abstract Objectives: to evaluate factors associated with neonatal near miss and death in reference hospitals. Methods: this case-control study included 364 cases and 728 controls among 4,929 births. Cases were identified by Apgar < 7 at 5 minutes, weight < 1500 g, gestational age <32 weeks, mechanical ventilation or congenital malformation. After follow-up, outcomes were reclassified into true controls, near miss and neonatal death. Hierarchically, variables with a p-value < 0.20 were included in the multiple logistic regression. Results: the neonatal near miss rate was 54.1 per 1,000 live births, and the near-miss-to-death ratio was 2.75. Between the control and near miss groups, the predictor variables were neonatal intensive care admission [OR = 35.6 (16.7 - 75.9)] and central venous access [OR= 74.8 (29.4 - 190.4)]. Between the control and death groups, neonatal intensive care admission [OR = 100.4 (18.8 - 537.0)] and central venous access [OR = 12.7 (3.7 - 43.2)] were significant. Between the near miss and death groups, only Apgar < 7 at 5 minutes [OR = 4.1 (1.6 - 10.6)] and vasoactive drug use [OR = 42.2 (17.1 - 104.5)] were significant. Conclusion: factors associated with a greater chance of near miss and/or neonatal death were Apgar score <7 at 5 minutes, neonatal intensive care confinement, having central venous access, and use of vasoactive drugs.

RESUMO

Resumo Objetivos: avaliar fatores associados à morbidade "near miss" e óbito neonatal em maternidade pública de referência. Métodos: estudo caso-controle com 4,929 nascimentos encontrou 364 casos e 728 controles. Os casos foram identificados pelos critérios Apgar< 7 no 5° minuto, peso <1500g, idade gestacional < 32 semanas, ventilação mecânica ou malformação congênita. Reclassificou-sequanto aos desfechos sobrevivência ao período neonatal sem critérios de near miss ("controles" verdadeiros), "near miss" e "óbito neonatal". Hierarquicamente, as variáveis com p< 0,20 foram incluídas na regressão logística múltipla. Resultados: a taxa de near miss neonatal foi 54,1 por mil nascidos vivos, a razão de near miss e óbito foi 2,75. As variáveis preditoras, entre controles e near miss foi internamento em terapia intensiva neonatal OR 35,6 (16,7 - 75,9) e acesso venoso central OR= 74,8 (29,4 -190,4); entre controles e óbito internamento em terapia intensiva neonatal OR=100,4 (18,8 - 537,0)e acesso venoso central OR 12,7 (3,7 - 43,2); entre near miss e óbito Apgar no 5°minuto < 7 OR= 4,1 (1,6 - 10,6) e uso de drogas vasoativas OR= 42,2 (17,1 - 104,5). Conclusão: fatores associados à ocorrência de near miss e/ou óbito neonatal foram Apgar < 7 no 5° minuto, internamento em terapia intensiva neonatal, acesso venoso central e drogas vasoativas.