Características epidemiológicas da mortalidade neonatal e infantil em uma regional de saúde / Epidemiological characteristics of neonatal and infant mortality in a health regional area

Objetivou-se analisar o perfil epidemiológico e as causas da mortalidade neonatal e infantil, em uma Regional de Saúde, de janeiro/2018 a agosto/2020. Trata-se de pesquisa exploratória, descritiva, transversal, retrospectivo, com abordagem quantitativa. A coleta de dados ocorreu em agosto de 2020, por meio de questionário elaborado pelas pesquisadoras, com base nas declarações de óbito disponibilizadas no Sistema de Informações de Mortalidade. O instrumento abordou as variáveis, sexo, raça, cor, idade da criança, idade materna, escolaridade materna, via de parto, idade gestacional, peso ao nascer, causa do óbito. Os dados foram submetidos à análise estatística descritiva e distribuição de frequência, por meio do Statistical Package for the Social Sciences (SPSS), versão 25.0. Constatou-se o predomínio de óbitos no sexo masculino (56,5%), de raça branca (87,8%), com equivalência entre extremo baixo peso e adequado (31,3%), com a principal causa de óbito por septicemia (13,9%). Quanto aos dados maternos, prevaleceram idade entre 21 e 30 anos de idade (45,2%) com gestação única (85,21%) e parto cesariano (65,2 %). Desses, 47,87% ocorreram no ano de 2018. Analisar os aspectos da mortalidade neonatal e infantil possibilita o planejamento e a readequação de ações no atendimento à saúde da criança, durante o período mais vulnerável e mais crítico dela, contribuindo, assim, para redução do número de óbitos.

This study analyzed the epidemiological profile and the causes of neonatal and infant mortality in a Health Regional Area between January 2018 and August 2020. This is an exploratory, descriptive, cross-sectional, retrospective study with a quantitative approach. Data collection took place during August 2020 through a questionnaire prepared by the researchers, based on the death certificates available in the Mortality Information System. The instrument included the variables of sex, race, color, child's age, mother's age, maternal education, childbirth mode, gestational age, birth weight, cause of death. The data were submitted to descriptive statistical analysis and frequency distribution using the Statistical Package for the Social Sciences (SPSS) version 25.0. There was a predominance of deaths among boys (56.5%), Caucasian (87.8%), with equivalence between extreme low and adequate weight (31.3%), with the main cause of death being septicemia (13.9%). As for maternal data, age between 21 to 30 years old (45.2%) prevailed, and 85.21% had a single pregnancy, with C-section childbirth (65.2%). From these, 47.87% occurred in 2018. It can be concluded that analyzing the aspects of neonatal and child mortality enables the planning and adjustment of actions in child health care during its most vulnerable and most critical period, thus contributing to reducing the number of deaths.

Mortalidad por sepsis neonatal entre los años 2016 y 2020 en Chile: una mirada nacional / Mortality due to neonatal sepsis between 2016 and 2020 in Chile: a national perspective

Introducción: La sepsis neonatal (SN) es una infección sistémica que ocurre antes de los 90 días de vida y que representa una amenaza potencialmente mortal. Esta investigación busca describir la tendencia de defunción por SN en Chile, durante el periodo 2016-2020. Materiales y métodos: Estudio descriptivo observacional, que incluyó a niños fallecidos por SN (n=249) en el periodo 2016-2020 en Chile según datos del departamento de estadísticas e información de salud de Chile. Las variables estudiadas fueron: año de fallecimiento, grupo etario, sexo, región y agente etiológico. No se requirió comité de ética. Resultados: El 2020 tuvo la menor tasa de mortalidad por SN (0,17) y el 2017 la mayor (0,31). El grupo etario de 0-2 días de nacido tuvo la mayor tasa de mortalidad (0,07), mientras que el grupo de 27-28 días corresponde a la menor (0,00). La región de Antofagasta tuvo la mayor mortalidad (0,44) y la región de Magallanes la menor (0,11). La tasa de mortalidad promedio en hombres corresponde a 0,12 y en mujeres a 0,10. En el 89,16% de los casos no se identificó el agente etiológico. Discusión: La mayor mortalidad en 2017 podría deberse a una proporción más alta de nacimientos pretérmino en dicho año. La mayor cantidad de defunciones a menor edad cronológica estaría relacionada con su inmadurez inmunológica. La no detección del agente etiológico pudo deberse al bajo rendimiento de los hemocultivos. Sin embargo, faltan más investigaciones acerca de la incidencia y mortalidad por sepsis neonatal.

Introduction: Neonatal sepsis (NS) is a systemic infection that occurs before 90 days of life and represents a life-threatening threat. This research seeks to describe the trend of death by NS in Chile, during the period 2016-2020. Materials and methods: Observational descriptive study, which included children who died due to NS (n=249) in the period 2016-2020 in Chile, according to data from the Department of Statistics and Health Information of Chile. The variables studied were: year of death, age group, sex, region and etiological agent. No ethics committee was required. Results: 2020 had the lowest mortality rate due to NS (0.17) and 2017 the highest (0.31). The age group of 0-2 days of birth had the highest mortality rate (0.07), while the group of 27-28 days corresponds to the lowest (0.00). The Antofagasta region had the highest mortality (0.44) and the Magallanes region the lowest (0.11). The average mortality rate in men corresponds to 0.12 and in women to 0.10. In 89.16% of the cases, the etiological agent was not identified. Discussion: The higher mortality in 2017 could be due to a higher proportion of preterm births in that year. The greater number of deaths at a lower chronological age would be related to their immunological immaturity. The non-detection of the etiological agent could be due to the low yield of the blood cultures. However, more research on the incidence and mortality from neonatal sepsis is lacking.

Prevalence and factors associated with neonatal sepsis among hospitalized newborns at Ruvuma, southern Tanzania

Introduction: Neonatal sepsis is one of the most common causes of neonatal morbidity and mortality in developing countries.Objective: This study aimed to determine the prevalence and factors associated with neonatal sepsis among hospitalized new-borns at Ruvuma, southern Tanzania.Methods: A facility-based retrospective study was conducted at Songea Regional Referral hospital in Ruvuma, during August-October, 2018. A standardized questionnaire was used to collect demographic, obstetric and clinical information from medical case files of patients. Neonatal sepsis was diagnosed clinically. Data were analysed using SPSS version 24.0. Chi square test was used to assess relationship between outcome and exposure variables. Multivariate logistic regression was used to measure association after controlling for confounders, and P-values of <0.05 were statistically significant.Results: Medical case files of 263 neonates were reviewed. Of these, 131(49.8%) had sepsis. Factors associated with neonatal sepsis were prematurity (AOR=2.2; 95%CI. 1.3 ­ 3.6, p=0.002), age of more than a week (AOR=2.2; 95%CI. 1.0 ­ 4.6, p=0.04), intravenous cannulation after birth (AOR=6.3; 95%CI. 2.1 ­ 19.0, p=0.002), and resuscitation with nasal oxygen prongs (AOR=1.7; 95%CI. 1.1 ­ 2.9, p=0.02).Conclusions: Neonatal sepsis is relatively common among neonates in Ruvuma and is associated with maternal and health services related factors. The findings underscore the importance of routine assessment and close monitoring of neonates

Restricción de crecimiento aumenta el riesgo de displasia broncopulmonar, muerte y sepsis en gemelos de 30 o menos semanas de gestación / Growth restriction increases the risk of bronchopulmonary dysplasia, death, and sepsis in twins of 30 weeks or less of gestation

INTRODUCCIÓN: Múltiples factores influyen en el riesgo de morbimortalidad del prematuro con restricción del crecimiento intrauterino (RCIU). La comparación de gemelos con crecimiento intrauterino discordante permite evaluar su efecto, excluyendo factores maternos y manejo prenatal. Nuestro objetivo fue evaluar el efecto de la RCIU sobre la morbilidad aguda, crónica y mortalidad, en parejas de recién nacidos gemelares prematuros extremos. PACIENTES Y MÉTODO: Gemelos menores de 1500 g y 30 semanas de gestación, de la Red Neocosur. Se realizaron análisis separados de pares de gemelos concordantes, discordantes leves y severos, evaluando el efecto de la RCIU sobre morbi-mortalidad. Se realizó análisis multivariado para establecer magnitud del efecto. RESULTADOS: 459 pares de gemelos, 227 concordantes, 110 discordantes leves y 122 severos. Entre los concordantes solo hubo diferencia en uso de oxígeno a las 36 semanas. En discordantes leves, el menor tuvo menos enfermedad de membrana hialina y requirió menos dosis de surfactante, pero tuvo un mayor riesgo de Displasia broncopulmonar (DBP) o muerte. En discordantes severos, el menor presentó mayor mortalidad, sepsis, utilización y permanencia en ventilación mecánica, pese a menor frecuencia de enfermedad de membrana hialina. En regresión múltiple, el riesgo combinado de DBP o muerte fue mayor en gemelo menor y discordante severo. CONCLUSIÓN: En gemelos discordantes, la patología respiratoria aguda fue más frecuente en el gemelo mayor, aunque el riesgo de DBP o muerte fue mayor en el gemelo con RCIU.

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.

Epidemiology of neonatal sepsis and associated factors implicated: observational study at neonatal intensive care unit of Arsi University Teaching and Referral Hospital, South East Ethiopia

BACKGROUND: Globally, sepsis remains one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units. The major burden of the problem occurs in the developing world while most evidence is derived from developed countries. The objective of this study was to evaluate the epidemiology of neonatal sepsis and associated factors among neonates admitted to Neonatal Intensive Care Unit (NICU). METHODS: Hospital based prospective cross-sectional study was conducted from April 2016 to May 2017. Neonates with clinical sepsis were included into the study. Data were analyzed using SPSS version 20. Frequencies, proportion and summary statistics were used to describe the study population in relation to relevant variables. Multivariate logistic regressions were used to assess factors associated with neonatal sepsis. p-values of < 0.05 were considered statistically significant. RESULTS: A total of 901neonates were admitted to NICU of which 303 neonates were admitted with diagnosis of clinical sepsis making the prevalence of neonatal sepsis to be 34%. Bacteremia were confirmed in 88/303(29.3%) of clinical sepsis, and gram-positive bacteria constituted 47/88(53.4%). Of all positive blood cultures, 52/88(59.1%) were reported from late onset sepsis. Coagulase negative staphylococcus (CoNS) accounted for 22/88(25%) followed by E. coli and S. aureus, each contributing 18/88(20.3%) and 16/88(18.2%) respectively. Prolonged PROM, low fifth Apgar score, prematurity and low birth weight were strongly associated with increased risk of neonatal sepsis. Neonates born to mothers who received antibiotics during labor and delivery were at significantly lower risk of acquiring neonatal sepsis. CONCLUSION: The prevalence of neonatal sepsis was high, and most causes of neonatal sepsis were gram positive bacteria and most bacteria isolates were from late onset sepsis. Obstetric factors were strongly associated with development of neonatal sepsis. Intrapartal antibiotic administration significantly reduces neonatal sepsis

Tratamiento antibiótico empírico inicial prolongado y riesgo de morbimortalidad en recién nacidos de muy bajo peso al nacer / Prolonged initial empirical antibiotic treatment and the risk of morbidity and mortality in very low birthweight infants

Resumen: Introducción: El objetivo de este estudio es evaluar la asociación entre la duración del tratamien to antibiótico empírico inicial y el desarrollo posterior de sepsis tardía, enterocolitis necrotizante (NEC) y muerte en recién nacidos de muy bajo peso al nacer (RNMBP). Pacientes y Método: Estudio cuantitativo, transversal analítico, en RNMBP ingresados a UCI neonatal durante un período de 5 años. Se consideró antibioterapia empírica inicial aquella que comenzó desde el nacimiento, sin conocer resultado de hemocultivos. Antibioterapia prolongada se estimó cuando la duración del tratamiento fue > 5 días. Se analizaron variables perinatales, e incidencia de sepsis tardía, NEC confirmada y mortalidad. Resultados: Se estudiaron un total de 266 RNMBP, con edad gestacional y peso de nacimiento promedios de 28,8 ± 2,5 semanas y 1.127 ± 264 g respec tivamente. Recibieron antibioterapia empírica inicial 213 (80,0%), siendo ésta prolongada en el 67,6%. Todos recibieron antibioterapia biasociada. Se pesquisaron 136 episodios de sepsis tardía, siendo los gérmenes más frecuentes el Staphylococcus coagulasa negativo y el Staphylococcus au reus. Del total de RN con antibioterapia empírica prolongada, hubo 20 casos de NEC confirmada y 15 fallecidos (10,4%) en el grupo analizado. Al comparar el uso de antibioterapia > 5 días ver sus tratamiento menor de 5 días, se observó una asociación estadísticamente significativa entre la antibioterapia prolongada y sepsis tardía (p = 0,03) y además de NEC confirmada (p = 0,03), pero no de mortalidad (p = 0,12). Conclusión: El uso de antibioterapia empírica inicial por 5 días o más se asoció a un riesgo aumentado de sepsis tardía y de NEC, pero no de la mortalidad en RNMBPN.

Abstract: Introduction: The objective of this study is to evaluate the association between the duration of ini tial empirical antibiotic treatment and the subsequent development of late-onset sepsis, necrotizing enterocolitis (NEC) and death in very low birth weight (VLBW) infants. Patients and Methods: Quantitative, cross-sectional, analytical study of VLBW infants admitted to the neonatal ICU were included over a period of five years. Initial empirical antibiotic therapy was that which started im mediately after birth, without knowing the results of blood cultures. It was considered prolonged antibiotic therapy when the treatment duration was > 5 days. Perinatal variables, as well as the inci dence of late-onset sepsis, confirmed NEC and mortality were analyzed. Results: 266 VLBW infants were studied, with an average gestational age and birth weight of 28.8 ± 2.5 weeks and 1.127 ± 264 g respectively. 213 infants received initial empiric antibiotic therapy (80.0%), which was prolonged in 67.6% of cases. All infants received two different antibiotics. 136 episodes of late-onset sepsis were described. The most common pathogens were coagulase-negative Staphylococcus and Staphylococcus aureus. Among the newborns with prolonged antibiotic therapy, there were 20 cases of confirmed NEC and 15 of the studied infants died (10.4%). When comparing the use of antibiotic therapy during > 5 days versus treatment less than 5 days duration, a statistically significant association was observed between prolonged antibiotic therapy and late-onset sepsis (p = 0.03) and confirmed NEC (p = 0.03), but not of mortality (p = 0.12). Conclusion: The use of empirical antibiotic therapy for five days or more was associated with an increased risk of late-onset sepsis and NEC, but not of mortality in VLBW infants.

Asociación de factores obstétricos y neonatales con casos de sepsis neonatal temprana. Cartagena, Colombia / Association of obstetric and neonatal factors with cases of early neonatal sepsis. Cartagena, Colombia

Introducción: La sepsis neonatal temprana es un problema de salud pública y es la principal causa de complicaciones y fallecimientos en las unidades de cuidado intensivo neonatales. Objetivo: Asociar factores de riesgo obstétrico y neonatal con la presencia de sepsis temprana en Cartagena (2014-2015). Material y Métodos: Se realizó un estudio retrospectivo de casos y control. La muestra son 183 casos y 366 controles, incluye pacientes que cumplan simultáneamente criterios de inclusión y exclusión. Se realizó análisis bivariado y se construyó modelo multivariado de regresión logística. Resultados: Entre las variables asociadas con sepsis temprana en las que se pudo definir el riesgo se encuentran la ruptura prematura de membrana >18 horas (OR 12,78 IC 95 por ciento 4,01-36,6), el riesgo de sepsis por parto vaginal (OR 2,69 IC 95 por ciento 1,58-4,57), el sexo masculino del recién nacido (OR 2,38 IC 95 por ciento1,38-4,08), y la prematuridad (OR 3,13 IC 95 por ciento 1,24-7,86) Conclusiones: En las madres con ruptura prematura de membranas y recién nacidos prematuros nacidos por vía vaginal es evidente una asociación causal con los casos de sepsis neonatal temprana(AU)

Introduction: Early neonatal sepsis is a public health problem and the leading cause of complications and deaths in neonatal intensive care units. Objective: To associate obstetric and neonatal risk factors with the presence of early sepsis in Cartagena (2014-2015). Material and Methods: Case Study and Retrospective Controls. The sample is composed of 183 cases and 366 controls, including patients who simultaneously meet inclusion and exclusion criteria. A bivariate analysis was performed and a logistic regression multivariate model was constructed. Results: Among the variables associated with early sepsis in which the risk could be defined, the following may be listed: premature rupture of membrane > 18 hours (OR 12.78 CI 95 percent 4.01-36.6), risk of sepsis due to vaginal childbirth (OR 2.69 95 percent CI 1.58-4.57), male newborn (OR 2.38 95 percent CI 1.38-4.08), and prematurity (OR 3.13 IC 95 percent 1.24-7.86). Conclusions: In mothers with premature rupture of membranes and vaginally born premature infants, a causal association with cases of early neonatal sepsis is evident(AU)

Sepse neonatal: mortalidade em município do sul do brasil, 2000 a 2013 / Neonatal sepsis: mortality in a municipality in southern brazil, 2000 to 2013

RESUMO Objetivo: Descrever o coeficiente de mortalidade neonatal por sepse e outras causas, além das características maternas, gestacionais, do parto, do recém-nascido e do óbito em Londrina, Paraná. Métodos: Estudo transversal e de séries temporais. Foram estudados óbitos neonatais que continham, em qualquer campo da declaração de óbito, registro de sepse neonatal, entre 2000 e 2013. Os anos foram agrupados em biênios e realizou-se cálculo do coeficiente de mortalidade neonatal e por causas específicas, segundo 10ª revisão da Classificação Internacional de Doenças (CID-10). Para a análise bivariada, considerou-se p<0,05, com cálculo da razão de prevalência e intervalo de confiança de 95% (IC95%). Resultados: Dos 745 óbitos, em 229 (30,7%) registrou-se sepse, com coeficiente de mortalidade neonatal de 7,5 óbitos por mil nascidos vivos (NVs), estando a sepse envolvida em 2,3 óbitos por mil NVs. As causas básicas da mortalidade neonatal foram afecções originadas no período perinatal e malformações congênitas. A sepse associou-se a pré-eclâmpsia, infecção do trato urinário, Apgar no 1º e 5º minutos e ocorrência de óbito tardio. Na análise descritiva de tendência, destacou-se o aumento na proporção de mães com 35 anos ou mais e com oito ou mais anos de estudo. A cobertura de pré-natal foi elevada, porém pouco mais da metade das mães realizou sete ou mais consultas. Conclusões: Nos 14 anos estudados, destacam-se o papel do pré-natal como ação preventiva dos agravos maternos e fetais e o aumento da idade e da escolaridade materna associados com a mortalidade neonatal.

ABSTRACT: Objective: To describe the neonatal mortality coefficient attributed to sepsis and other causes, and to report the maternal, neonatal and death characteristics of newborn infants that died in the city of Londrina, Paraná, in Southern Brazil. Methods: This is a cross-sectional study with a time series analysis. Neonatal deaths that contained neonatal sepsis records in any field of the death certificate between the years 2000 and 2013 were studied. The years were grouped into biennia, and cause specific neonatal mortality coefficient was calculated, according to the International Classification of Diseases, 10th revision. Results are expressed as prevalence ratio and 95% confidence interval (95CI%). For bivariate analysis, p<0.05 was considered significant. Results: Among the 745 deaths, 229 (30.7%) had sepsis, with a neonatal mortality coefficient of 7.5 per one thousand livebirths. Sepsis was involved in 2.3 deaths per 1,000 live births. The main underlying causes were conditions originated in the perinatal period and congenital malformations. Sepsis was associated with pre-eclampsia, urinary tract infection, Apgar in the 1st and 5th minutes, and occurrence of late death. In the descriptive trend analysis, there was an increased proportion of mothers aged 35 years or older and with eight or more schooling years. Prenatal coverage was high, but a little more than half of the mothers attended seven or more medical appointments. Conclusions: In the 14 years analyzed, the prenatal care was identified as a preventive measure against maternal and fetal disorders and the advanced maternal age was associated with neonatal mortality.

Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus / Terapia antimicrobiana empírica para sepse tardia na unidade neonatal com alta prevalência de Staphylococcus coagulase negativo

Abstract Objective: The aim of this study was to compare two different empiric treatments for late-onset neonatal sepsis, vancomycin and oxacillin, in a neonatal intensive care unit with a high prevalence of coagulase-negative Staphylococcus. Methods: A cross-sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. Data from the medical records of at-risk newborns were collected daily. Infections were defined according to the National Health Surveillance Agency criteria. Data analysis was performed using an internal program. Results: There was a significant reduction in the number of Staphylococcus aureus infections (p = 0.008), without endocarditis, meningitis, or lower respiratory tract infection, as well as a reduction in the frequency of deaths related to S. aureus infection. There were no significant changes in the incidence of Gram-negative bacterial or fungal infections. An increase in coagulase-negative Staphylococcus infections was observed (p = 0.022). However, there was no measured increase in related morbidity and mortality. There was a reduction in the median number of days of treatment with oxacillin from 11.5 to 6 days (p < 0.001) and an increase of one day in the median number of days of treatment with vancomycin (p = 0.046). Conclusions: Modification of the empiric treatment regimen for neonatal late-onset sepsis with use of oxacillin showed a significant reduction in S. aureus infections, as well as a reduction in the frequency of infections with major organ system involvement and mortality due to infection with this microorganism. As a result, oxacillin can be considered as an effective treatment for late-onset sepsis, making it possible to avoid broad-spectrum antibiotics.

Resumo Objetivo Comparar dois períodos com diferentes esquemas empíricos para tratamento de sepse neonatal tardia, incluindo vancomicina ou oxacilina respectivamente, em unidade neonatal de referência com alta prevalência de Staphylococcus coagulase negativo. Métodos Estudo transversal, feito em unidade neonatal de referência, de 2011 a 2014. Os dados foram coletados diariamente por vigilância ativa em prontuário de recém-nascidos de risco. As infecções foram notificadas conforme critérios definidos pela Agência Nacional de Vigilância Sanitária. O banco de dados e a análise foram feitos em programa interno. Resultados Ocorreu redução significativa da notificação de infecções por Staphylococcus aureus (p = 0,008), sem notificações de endocardite, meningite e infecções de vias aéreas inferiores, além de redução na frequência de óbitos pelo microrganismo e sem alteração significativa nas incidências de infecções por bactérias Gram negativas e fungos. Houve aumento de infecções S. aureus coagulase negativo (p = 0,022), mas sem aumento de morbidade e mortalidade. Ocorreu redução na mediana do tempo de uso de oxacilina, de 11,5 para 6 dias (p < 0,001), com aumento de mediana de um dia de uso de vancomicina (p = 0,046). Conclusões A modificação do esquema empírico com uso de oxacilina revelou redução significativa das infecções por S. aureus, além da redução na frequência de infecção de foco profundo e mortalidade pelo microrganismo. Considera-se que oxacilina pode ser usada como esquema de tratamento de sepse neonatal tardia para se evitar o uso de antibióticos de largo espectro.