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Abstract Objectives: This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Method: This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals' knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. Results: Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. Conclusion: Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.
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OBJECTIVES: Low cardiac output syndrome (LCOS) is a serious complication after cardiac surgery and is associated with significant morbidity and mortality. The aim of this study is to identify risk factors for LCOS in patients undergoing coronary artery bypass grafting (CABG) in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brazil). METHODS: A historical prospective study comprising 605 consecutive patients operated between May 2007 and December 2010. We evaluated 12 preoperative and 7 intraoperative variables. We applied univariate and multivariate logistic regression analysis. RESULTS: The incidence of LCOS was 14.7% (n = 89), with a lethality rate of 52.8% (n = 47). In multivariate analysis by logistic regression, four variables remained as independent risk factors: age > 60 years (OR 2.00, 95% CI 1.20 to 6.14, P = 0.009), on-pump CABG (OR 2.16, 95% CI 1.40 to 7.08, P = 0.006), emergency surgery (OR 4.71, 95% CI 1.34 to 26.55, P = 0.028), incomplete revascularization (OR 2.62, 95% CI 1.32 to 5.86, P = 0.003), and ejection fraction <50%. CONCLUSIONS: This study identified the following independent risk factors for LCOS after CABG: age> 60 years of off-pump CABG, emergency surgery, incomplete CABG and ejection fraction <50%.
OBJETIVOS: A síndrome de baixo débito cardíaco (SBDC) é uma complicação grave após cirurgias cardíacas, estando associada à significativa morbidade e mortalidade. O objetivo deste estudo é identificar fatores de risco para SBDC em pacientes submetidos à cirurgia de revascularização miocárdica (CRM), na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brasil). MÉTODOS: Estudo prospectivo histórico compreendendo 605 pacientes consecutivos operados entre maio de 2007 e dezembro de 2010. Avaliaram-se 12 variáveis pré-operatórias e sete variáveis intraoperatórias. Aplicaram-se análises univariada e multivariada por regressão logística. RESULTADOS: A incidência de SBDC foi de 14,7% (n = 89), com taxa de letalidade de 52,8% (n = 47). Na análise multivariada por regressão logística, quatro variáveis permaneceram como fatores de risco independentes: idade > 60 anos (OR 2.00, IC 95% 1,20 a 6,14, P = 0,009), CRM com circulação extracorpórea (OR 2,16, IC 95% 1,40 a 7,08, P = 0,006), cirurgia de emergência (OR 4,71, IC 95% 1,34 a 26,55, P = 0,028), CRM incompleta (OR 2,62, IC 95% 1,32 a 5,86, P = 0,003) e fração de ejeção < 50% (OR 1,87, IC 95% 1,17 a 3,98, P = 0,007). CONCLUSÕES: Este estudo identificou os seguintes fatores de risco independentes para SBDC após CRM: idade > 60 anos, CRM com CEC, cirurgia de emergência, CRM incompleta e fração de ejeção < 50%.