Navegando por Palavras-chave "Mortalidade neonatal"

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    Epidemiologia dos óbitos neonatais hospitalares associados à asfixia perinatal em Maceió, Alagoas, 2009
    (Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Oliveira, Junko Asakura Bezerra de [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Alagoas has the highest infant and neonatal mortality rates among all the States of Brazil and thus it urges to know its determinants. Aim: to describe the epidemiology of neonatal mortality associated with asphyxia in public maternity hospitals, besides the infra-structure of neonatal assistance, in Maceió, capital of Alagoas State, in 2009. Methods: This is a cross-sectional study with daily active search for medical records of mothers and their newborns who died under 28 days of age in 8 public maternity hospitals in Maceió, from Jan/1st until Dec/31st 2009. Death was considered associated with asphyxia if, at least, one criteria was present: Apgar score <6 at 5 minutes; meconium aspiration syndrome (MAS); hypoxic-ischemic encephalopathy; Apgar score <3 in the 1st minute with ventilation at birth; death record of hypoxia/asphyxia at birth. Patients with major malformations, birth weight <400g or gestational age <22 weeks were excluded. Descriptive analysis of patients included the variables of location and condition of birth and death, morbidity and therapeutic interventions. Information on physical structure, material and human resources were collected from hospitals in March and September/09. Results: In 2009, in the eight public maternity hospitals 20860 babies were born and there were 326 neonatal deaths, of which 243 (74%) were preventable. Asphyxia was present in 113 (46%) cases, of which 15 died without intensive care and 24 came from others institutions. Out of 113 deaths, 12 did not receive any resuscitation procedures and nine of them were 22-27 weeks old. Out of 86 low birth weight newborns, 79 (92%) were born with obstetrician and pediatrician care, 75 (87%) developed respiratory distress syndrome, 41 (48%) received surfactant and 41 had neonatal sepsis. Ten (37%) of the group with birth weight >2500g (27 newborns) were born without obstetrician nor pediatrician care and 17 (68%) had meconium aspiration syndrome. Regarding the interventions, 7 did not receive mechanical ventilation, 19 (70%) received aminas and only 2 had monitored blood pressure. Out of 113 deaths, 42% died before 24h and 42% between 2 and 6 days after birth. The death registration referred asphyxia in 37% of the cases and necropsy was performed in 4 cases. In the eight public maternity hospitals, where there were born 1 to 12 newborns, the number of resuscitation tables ranged from 1 to 3. Four public maternities had physical infrastructure, material and equipment for neonatal resuscitation in the delivery room. There were pediatricians all the time in seven maternities; 62% of the pediatricians attended a neonatal resuscitation course in the last two years. Out of the nursing staffs, 49% attended to the course, but one staff had never attended one. The physical infrastructure, material and equipment did not change along the year. Conclusion: In the City of Maceio, in 2009, asphyxia at birth was presented in half of the neonatal death in-hospital. In the majority of the cases there were pediatricians in the delivery room, mainly in the low birth weight cases. There were neonatal deaths in intermediate care units, and it shows the frailty of physical infrastructure and equipments, associated to the severity at birth.
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    Epidemiologia dos óbitos neonatais hospitalares associados à asfixia perinatal no interior do Estado de Alagoas em 2009
    (Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Silva, Cicero José da [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To describe epidemiologic frequency and characteristics of intra-hospital neonatal deaths associated to perinatal asphyxia in the country side of Alagoas state in 2009. Method: Prospective cross-seccional study with weekly active search for medical records of mothers and their newborn infants who died before 28 days of age from January 1st to December 31, 2009, in 11 maternity hospitals from 7 towns which account for 67% of newborn births in the country side of Alagoas. This study was approved by the Research Ethics Committee as well as by all the 11 maternity hospitals. It was considered death associated to perinatal asphyxia if at least one of these criteria was found: Apgar score <6 in the 5th minute; meconium aspiration syndrome (MAS); hypoxic-ischemic encephalopathy; Apgar score <3 in the 1st minute with ventilation at birth; death record of hypoxia/asphyxia at birth in the Declaration of Death. Patients with major malformations, birth weight <400g or gestational age <22 weeks were excluded. Descriptive analysis of patients included the variables of location and condition of birth and death, morbidity and therapeutic interventions. Information on physical structure, material and human resources were collected from hospitals in March and September/09. Results: In 2009, in 11 hospitals were registered 19,740 live births and 173 neonatal deaths, 155 were preventable, of which 100 (65%) had birth asphyxia (5.1 deaths per thousand live births) and 91% occurred at the same hospital of birth. Obstetrician and pediatrician were present, respectively, in 83% and 91% of the births of the 53 infants with low birth weight and 77 and 79% of 47 infants 2500g. Apgar score 3 in the 1st minute occurred in 83% of the 53 low birth weight newborn and 1/3 of them had no improvement at 5 minutes score; 92% developed respiratory distress, 46% received surfactant, 70% mechanical ventilation and 73% remained in incubator. Of the 61 infants >2500g, 47(77%) had asphyxia, half of them had 1st minute Apgar score 3 and 17% of whom remained unchanged at 5 min. MAS was clinically diagnosed in 59% of this group, 59% received mechanical ventilation and 56% remained in the incubator. Died outside environment intensive care 34% of low birth weight newborn infants and 62% of 2500g. Death occurred within 24 hours in 41% and between 2 and 6 days in 47% of the 100 newborn infants. Half of death certificates contained reference to asphyxia and no autopsy was performed. In March/2009, in each hospital there was a single neonatal resuscitation table for reception at birth and 7 had complete material for manual ventilation. In evaluating September/09, all tables had material for resuscitation. Two hospitals had neonatal ICU beds and 4 had care intermediate. Between 2007 and 2009, 58% of pediatricians and 25% of staff nursing had done neonatal resuscitation training course. Conclusion: The rate of neonatal deaths with birth asphyxia in the interior of Alagoas is very high (65%), especially in newborns weighing over 2,500g, identifying inadequate conditions of care in delivery rooms and in neonatal care units.
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    Estudo de Caso: Gestante de risco e Óbito neonatal
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-03) Miranda, Naiara Hasegawa de [UNIFESP]; Devincenzi, Macarena Urrestarazu [UNIFESP]; http://lattes.cnpq.br/9369073345790021; http://lattes.cnpq.br/8680135914512908; Universidade Federal de São Paulo (UNIFESP)
    Trata-se de um estudo de caso desenvolvido através de abordagem qualitativa, em análise relacionada ao óbito neonatal no contexto da saúde materna. Os dados foram obtidos a partir das informações de uma pesquisa mais ampla a respeito de óbitos neonatais em famílias residentes da Zona Noroeste de Santos/SP, desenvolvida por meio de análise documental e entrevistas gravadas com posterior análise de conteúdo, que permitiu o registro da história de vida das mulheres, com destaque para aspectos da infância, juventude, reprodução e vida familiar. Para o estudo identificou-se um caso que envolve uma condição nutricional relacionada a conjuntura da gestação de risco e a experiência do óbito. A avaliação dos resultados parte do ponto de vista da atenção em saúde e perspectiva da mulher em relação ao óbito neonatal, ampliando o olhar da gestação de risco , na relação do profissional de saúde e usuária e dos processos na rede de saúde, visando a melhora na qualidade do cuidado integral de mulheres e crianças.
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    Execução de manobras de reanimação neonatal após treinamento com simulação realística de alta fidelidade
    (Universidade Federal de São Paulo, 2022-02-24) Conzi, Maria Florencia (UNIFESP); Almeida, Maria Fernanda Branco de [UNIFESP]; Kawakami, Mandira Daripa [UNIFESP]; http://lattes.cnpq.br/2740685997254275; http://lattes.cnpq.br/7346149704101984; http://lattes.cnpq.br/2232473095734159
    Introdução: A simulação realística é utilizada para o treinamento de profissionais de saúde em habilidades técnicas, cognitivas e comportamentais para aprimorar o desempenho na prática clínica. Objetivo: Comparar o tempo de indicação e execução dos procedimentos de reanimação neonatal realizados ao início e ao término do treinamento com cenários de simulação realística de alta fidelidade. Método: Estudo de intervenção realizado com 23 equipes (2 pediatras e 1 enfermeiro) provenientes de 23 maternidades públicas de 19 estados brasileiros em 2015-2016 no Laboratório de Simulação Realística Neonatal da Universidade Federal de São Paulo. A intervenção consistiu na atuação da equipe em diversos cenários de reanimação com simulador neonatal computadorizado (SimNewB, Laerdal®) dirigido por facilitadores neonatologistas por 8 horas. Os cenários foram gravados com três câmeras de alta resolução. Após randomização por sorteio de 205 vídeos, os tempos de indicação e execução dos procedimentos foram contados por 2 observadores independentes, verificando-se a concordância pelo teste de correlação intraclasse. Para cada equipe, comparou-se o tempo de indicação e de execução de cada procedimento ao início do primeiro e ao final do último cenário pelo teste de Wilcoxon pareado. Valores são expressos em mediana (p25-p75). Resultado: O tempo de graduação dos 46 pediatras era de 22 anos (13-26) e dos 23 enfermeiros de 8 anos (6-14); 89% dos pediatras e 48% dos enfermeiros recepcionavam recém-nascidos em salas de parto; 100% eram aprovados no curso de reanimação neonatal da Sociedade Brasileira de Pediatria com manequins de baixa fidelidade. Quanto à concordância dos valores entre os observadores, foi quase perfeita ou substancial para a maioria dos procedimentos. O tempo de execução dos passos iniciais da reanimação reduziu de 28,5s (19,0-43,0) para 17,5s (12,5-25,5) [p=0,003] e o tempo da instalação da oximetria de pulso foi de 47,5s (34,0-63,5) ao início e de 36,5s (23,0- 56,0) ao final da intervenção. Houve decréscimo no tempo para iniciar a aplicação da ventilação com pressão positiva (VPP) com máscara facial de 37,5s (31,0-67,0) para 25,0s (18,5-39,0) [p=0,01], enquanto o número de ventilações/minuto aumentou de 31,6 (28,0-39,7) para 37,6 (33,6-53,5) [p=0,003]. Já o tempo de indicação de intubação orotraqueal também diminuiu de 5,0s (3,5-8,0) para 3,5s (3,0-4,5) [p=0,003], com mediana de 1 tentativa com sucesso (1-1), sem alteração na realização da intubação em 20s (14-31) vs 17,0s (13,5-31,0). Entretanto houve acréscimo no número de ventilações/minuto por cânula de 38,2 (31,0-47,0) para 45,9 (32,8-53,5) [p=0,003]. Quanto à relação compressões cardíacas para VPP permaneceu em apenas em 2,6:1 (1,1-3,2) ao início e em 2,7:1 (1,7-3,2) ao final da intervenção. Conclusão: O treinamento baseado em simulação realística de alta fidelidade em reanimação neonatal das equipes de profissionais da saúde promove a redução do tempo de execução dos procedimentos, principalmente dos passos iniciais e para aplicação da VPP. Práticas periódicas em cenários de reanimação neonatal são necessárias para a aquisição de habilidades técnicas, cognitivas e comportamentais dos profissionais nas situações menos frequentes e de maior complexidade, como a massagem cardíaca acompanhada da ventilação.
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    Fatores perinatais associados ao óbito precoce em prematuros nascidos nos centros da Rede Brasileira de Pesquisas Neonatais
    (Sociedade Brasileira de Pediatria, 2008-08-01) Almeida, Maria Fernanda Branco de [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Martinez, Francisco Eulogio; Procianoy, Renato Soibelmann; Leone, Cléa Rodrigues; Marba, Sérgio Tadeu Martins; Rugolo, Lígia Maria Sousa Suppo; Luz, Jorge Hecker; Lopes, José Maria de Andrade; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade de Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Pediatria; Universidade Estadual de Campinas (UNICAMP); Universidade Estadual Paulista (UNESP)
    OBJECTIVE:To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. METHODS: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. RESULTS: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth. CONCLUSION: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.
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    Mortalidade neonatal associada à asfixia perinatal no estado de São Paulo : série histórica de 2004 a 2013
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-05) Kawakami, Mandira Daripa [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; http://lattes.cnpq.br/7346149704101984; http://lattes.cnpq.br/2740685997254275; Universidade Federal de São Paulo (UNIFESP)
    Objective:To analyze the temporal evolution of the neonatal deaths rate associated with perinatal asphyxia from 2004 to 2013 according to geographical distribution, gestational age (GA) and demographic variables in the State of São Paulo (SP State). Method: Populationbased study including deaths with perinatal asphyxia without congenital anomalies occurred during the first 27 days of life in São Paulo city, in the Metropolitan Area (Capital excluded) and in the countryside of the SP State from 2004 to 2013. Perinatal asphyxia was considered if intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome were written in any line of the original Death Certificate (DC). Data was collected from SEADE Foundation after the linkage of the DC with its respective Birth Certificate based on the deterministic linkage process. The statistics analysis was assessed through Poisson regression model, Kaplan Meier curves, chi-squared test for trend and multivariate Cox regression. Results: From 2004 to 2013, 6,648 deaths resulted from perinatal asphyxia in SSP: 27% in São Paulo city; 21% in the Metropolitan Area (Capital excluded) and 52% in the countryside. The rates of neonatal death with asphyxia in 1,000 live births were 1.16 in 2004 to 0.97 in 2013 in São Paulo city (reduction of 17%; p=0.082); from 1.45 to 0.83 in the Metropolitan Area (reduction of 43%; p<0.001) and from 1.48 to 0.98 ( reduction of 34% ; p<0.001) in the country side. In neonates with 22 to 27 weeks, the reduction rate was higher in the Metropolitan Area than in São Paulo city (p=0.035) and also in neonates from 32 to 36 weeks in the Metropolitan Area (p=0.013) and in the countryside (p=0.003) compared to São Paulo city, with the same reduction rate among the 3 regions for 28-31 weeks and for 37-41 weeks. The median life time until death was 24 hours: higher in São Paulo city (36 hours), followed from the countryside (23 hours) and Metropolitan Area (21 hours). The extreme premature infants had the lowest median time of life (13 hours) and the highest was among the 28-31 weeks (41 hours). Births were more frequent in their hometown, with the reduction of births in SUS hospitals at the Metropolitan Area (p=0.034) and in the countryside (p=0.019), and deaths were more frequent at the same hospital of birth. Teenager mothers were less frequent (p=0.039), with higher rates of primiparous mothers (p<0.001) and cesarean deliveries (p=0.019) and with death reduction among 37-41 weeks (p<0.001) along the ten years. Based on multivariate analysis, adjusting the death year, there was an association of life time to death with: region and birth place, mother’s age, number of prenatal consultations, type of delivery, GA, 1st minute Apgar score, race/colour and sex. Conclusion: Neonatal deaths with perinatal asphyxia reduced significantly during 2004 to 2013, mainly among 32-36 weeks in the Metropolitan Area and in the countryside, most probably due to medical interventions and public policies directed to the pregnant mother and the newborns, which had a great impact in those regions in the State of São Paulo.