RESUMO
A prematuridade é um problema mundial, sendo a principal causa de óbito neonatal. É o determinante mais importante de mortalidade infantil e assistência antenatal, parto e atendimento neonatal. Assim sendo, o objetivo deste trabalho foi analisar a prevalência de óbito em curto prazo e as principais complicações associadas em prematuros nascidos no Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ) de janeiro de 2011 a dezembro de 2017. Os dados foram coletados através de instrumento de coleta de dados. Os prematuros foram divididos em quatro grupos de acordo com a classificação de gravidade. Realizou-se a análise descritiva das variáveis e a seguir, variáveis associadas ao óbito em curto prazo foram determinadas por odds ratio (OR) e análise multivariada com regressão logística. Observou-se taxa de 9,8% de nascimentos prematuros, sendo 58,5% na faixa da prematuridade leve. A prevalência de óbitos total em curto prazo foi de 7,8%, sendo a maior taxa no grupo da prematuridade extrema (66,6%). A complicação neonatal mais frequente foi a síndrome do desconforto respiratório, seguida pela sepse, enterocolite necrosante e hemorragia intraventricular. As características que mostraram associação com o óbito foram a ausência de síndrome hipertensiva materna, a não administração de corticoide antenatal, o recém-nato do sexo masculino, escore de Apgar menor que 7 no quinto minuto e a presença de crescimento intrauterino restrito (CIUR). A presença de CIUR foi relacionada com o óbito na prematuridade grave, moderada e leve.
Prematurity is a worldwide problem, being the main cause of neonatal death. It is the most important determinant of infant mortality and antenatal care, delivery and neonatal care. Therefore, the objective of this study was to analyze the prevalence of death and the main complications associated in premature babies born in the Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ) from January 2011 to December 2017. The data were collected through an instrument of data collection. Premature infants were divided into four groups according to the severity classification(11). A descriptive analysis of the variables was performed, and then variables associated with death were determined by odds ratio (OR) and multivariate analysis with logistic regression. A rate of 9.8% of preterm births was observed, being 58.5% in the mild prematurity range. The prevalence of total deaths was 7.8%, the highest rate in the group of extreme prematurity (66.6%). The most frequent neonatal complication was respiratory distress syndrome, followed by sepsis, necrotizing enterocolitis and intraventricular hemorrhage. The characteristics that showed association with death were absence of maternal hypertensive syndrome, non-administration of antenatal corticoid, newborn male, Apgar score less than 7 in the fifth minute and the presence of restricted intrauterine growth (IUGR). The presence of IUGR was related to death in severe, moderate and mild prematurity.
RESUMO
PURPOSE--To analyze the clinical, laboratory and pathological aspects of 20 cases of infectious endocarditis (IE) who died. The authors compared patients with diagnosis before death of IE and those with diagnosis was made after autopsy. METHODS--Twenty patients who died with IE between April 1982 and November 1991 were studied. We looked for the clinical aspects (fever, cardiac murmurs, anemia, splenomegaly, embolic events and skin manifestation), laboratory aspects (hemocultures), echocardiographic and anatomopathologic features (valvar vegetations events and embolic accidents founded at autopsy). The sample was divided in two sub-groups: A--with clinical diagnosis of IE before and B--without diagnosis before death. RESULTS--Group A--9 patients aged 8-58 years, 3 men, all them with cardiac murmurs, fever and anemia, 5 with splenomegaly. Hemocultures were done in 7 patients and positive in 1. Echocardiogram with valvar vegetation were found in 4 out of 5 patients (80 per cent positive). At autopsy mitral valve vegetation were present in 7, aortic 3, tricuspid 3. One patient showed the exposure of three valves and two of 2 valves. Embolic events were found in 4. Group B--11 patients most of them older then 50 years (54.5 per cent) (p < 0.05) 5 men, all them presented fever and anemia. Cardiac murmurs in 6 (54 per cent) and none with splenomegaly. In one case hemoculture and echocardiogram, were done and were negative. Anatopathologic study showed compromise of mitral valve in 5, aortic 4, tricuspid 2, pulmonary 1. Two patients had 2 valves compromised. In one case a mural vegetation (right atrium) was found. Embolic events were present in 2 cases. CONCLUSION--In group B a significant number of patients (p < 0.05) were older than 50 years and presented his symptoms as an acute illness. We concluded that older patients with compromised general state and fever with or without embolic events IE must be remember