Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants / 浙江大学学报·医学版

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Caracterización de recién nacidos con depresión cardiorrespiratoria del Hospital Ginecobstétrico "Fé del Valle Ramos", Granma / Characterization of newborns with cardiorespiratory depression at the Hospital Ginecobstétrico "Fé del Valle Ramos" in Granma / Caracterização de recém-nascidos com depressão cardiorrespiratória no Hospital Gineco-obstétrico "Fé del Valle Ramos", Granma

RESUMEN Introducción: La depresión cardiorrespiratoria neonatal es un problema clínico que, en dependencia de su etiología, conduce a una alta morbilidad neurológica y elevada mortalidad. Objetivo: Caracterizar al recién nacido con depresión cardiorrespiratoria en el servicio de Neonatología del Hospital Ginecobstétrico "Fé del Valle Ramos", de Manzanillo, Granma. Método: Se realizó un estudio retrospectivo, observacional, descriptivo y transversal. Se seleccionaron 88 neonatos que cumplieron con los criterios de inclusión de recién nacido con depresión cardiorrespiratoria. Los datos se recolectaron durante el período de enero de 2017 a diciembre de 2018. Se tomaron en cuenta las siguientes variables: puntaje de Apgar, años de estudio, sexo, tipo de depresión cardiorrespiratoria, peso al nacer, factores maternos, edad gestacional y afecciones asociadas. Resultados: La depresión severa al nacer predominó en la mayoría de los neonatos (56,8 %). Prevalecieron los recién nacido de buen peso (73,9 %), nacidos a término (77,2 %). Las infecciones maternas (45,5 %) durante la gestación, el tiempo de rotura de membranas prolongado (31,8 %) y la presencia de líquido amniótico meconial (30,7 %), constituyeron los factores maternos que mayor vínculo guardaron con el neonato deprimido. Conclusiones: Las infecciones maternas, la rotura prematura de membranas, la presencia de líquido amniótico meconial, los nacimientos por cesárea, la nuliparidad, prematuridad y el embarazo en la adolescencia, son algunos de los factores de riesgo relacionados en este estudio que guardan vínculo estrecho con el predominio de estas afecciones en los neonatos deprimidos.

ABSTRACT Introduction: The cardiorespiratory depression in neonates is a clinical complication that, depending on its etiology, leads to high neurological morbidity and mortality. Objective: To characterize neonates with cardiorespiratory depression treated in the neonatology service at the Hospital Ginecobstétrico "Fé del Valle Ramos" in Manzanillo, Granma. Method: A retrospective, observational, descriptive and cross-sectional study was carried out. A total of 88 neonates with cardiorespiratory depression criteria were selected in the study. All information gathered includes the period January 2017 throughout December 2018. Variables assessed were as follow: Apgar score, years of study, sex, type of cardiorespiratory depression, birth weight, maternal factors, gestational age and associated conditions. Results: Severe depression at birth was predominant in most of neonates (56.8%). Newborn infants with a normal birth weight (73.9%), and born at term (77.2%) were predominant. Maternal infections during gestation (45.5%), prolonged rupture of membranes (31.8%) and the presence of meconium in the amniotic fluid (30.7%) were the maternal factors most associated with depressed neonate. Conclusions: The maternal infections, premature rupture of membranes, the presence of meconium in the amniotic fluid, cesarean birth, nulliparous status, premature and adolescent pregnancy are some of the risk factors assessed in this study that are closely linked to the prevalence of arising conditions in depressed neonates.

RESUMO Introdução: A depressão cardiorrespiratória neonatal é um problema clínico que, dependendo de sua etiologia, leva a alta morbidade neurológica e alta mortalidade. Objetivo: Caracterizar o recém-nascido com depressão cardiorrespiratória no serviço de Neonatologia do Hospital Gineco-obstétrico "Fé del Valle Ramos", Manzanillo, Granma. Método: Foi realizado um estudo retrospectivo, observacional, descritivo e transversal. Foram selecionados oitenta e oito lactentes que atenderam aos critérios de inclusão de um recém-nascido com depressão cardiorrespiratória. Os dados foram coletados no período de janeiro de 2017 a dezembro de 2018. Foram consideradas as seguintes variáveis: índice de Apgar, anos de estudo, sexo, tipo de depressão cardiorrespiratória, peso ao nascer, fatores maternos, idade gestacional e condições associadas. Resultados: A depressão grave ao nascer prevaleceu na maioria dos neonatos (56,8%). Prevaleceram os recém-nascidos de bom peso (73,9%) e a termo (77,2%). Infecções maternas (45,5%) durante a gestação, tempo prolongado de ruptura da membrana (31,8%) e presença de líquido amniótico mecônio (30,7%) foram os fatores maternos mais associados ao neonato deprimido. Conclusões: Infecções maternas, ruptura prematura de membranas, presença de líquido amniótico mecônio, partos cesáreos, nuliparidade, prematuridade e gravidez na adolescência, são alguns dos fatores de risco relacionados neste estudo que estão intimamente ligados ao predomínio dessas condições na recém-nascidos deprimidos.

Acute kidney injury in newborns with necrotizing enterocolitis: risk factors and mortality / Daño renal agudo en recién nacidos con enterocolitis necrotizante: factores de riesgo y mortalidad

Abstract Background: Both necrotizing enterocolitis and acute kidney injury are tightly related conditions, which independently increase mortality in newborns. Necrotizing enterocolitis is an inflammatory disease with a systemic repercussion that leads to inflammatory kidney changes predisposing to renal damage. Methods: This study assessed risk factors for the development of acute kidney injury in patients diagnosed with necrotizing enterocolitis and compared mortality between patients with or without acute kidney injury. Thirty-nine patients with the diagnosis of necrotizing enterocolitis were included, regardless of the gestational age. Results: Of 39 patients, 38.5% developed acute kidney injury. Survival showed to be significantly lower in patients with acute kidney injury (54.4 days) when compared to newborns without acute kidney injury (76.22 days; p = 0.014). Mortality in patients with acute kidney injury was 46.7%, increasing up to 62.5% with severe kidney damage. The hazard ratio for mortality was 4.708 for acute kidney injury (p = 0.025). The severity of enterocolitis showed to be an independent risk factor in developing acute kidney injury and severe kidney injury (odds ratio [OR] = 1.841, p = 0.034 and OR = 1.917, p = 0.027, respectively). Conclusions: Newborns with necrotizing enterocolitis should be evaluated for early recognition of acute kidney injury. Prospective studies with a higher number of patients are needed to identify modifiable risk factors to impact in the prevention of these conditions.

Resumen Introducción: La enterocolitis necrosante y el daño renal agudo son condiciones íntimamente relacionadas que incrementan independientemente la mortalidad en recién nacidos. La enterocolitis necrosante es una enfermedad inflamatoria sistémica que desencadena cambios renales inflamatorios, predisponiendo el desarrollo de daño renal. Métodos: Se analizaron los factores de riesgo para el desarrollo de daño renal agudo en pacientes con diagnóstico de enterocolitis necrosante y se comparó la mortalidad entre los pacientes sin daño renal y los pacientes con daño renal agudo. Se incluyeron 39 pacientes con diagnóstico de enterocolitis necrosante, independientemente de la edad gestacional. Resultados: De los 39 pacientes, el 38.5% desarrolló daño renal agudo. La sobrevida de los que desarrollaron daño renal agudo (54.4 días) mostró ser significativamente menor al compararse con los recién nacidos que no presentaron daño renal (76.22 días; p = 0.014). La mortalidad en los pacientes con daño renal agudo fue del 46.7%, que se incrementó hasta el 62.5% en aquellos con daño renal grave. El riesgo de mortalidad fue de 4.708 para daño renal agudo (p = 0.025). La gravedad de la enterocolitis necrosante demostró ser un factor de riesgo independiente para el desarrollo de daño renal agudo y de daño renal agudo severo (razón de momios [RM] = 1.841; p = 0.034 y RM = 1.917; p = 0.027, respectivamente). Conclusiones: Los recién nacidos con diagnóstico de enterocolitis necrosante deben ser evaluados para reconocer de forma temprana la presencia de daño renal agudo. Se requiere de estudios prospectivos con mayor número de pacientes para identificar factores de riesgo modificables que puedan impactar en la prevención de estas patologías.

Mortalidad neonatal y factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales / Neonatal mortality and associated factors in newborn infants admitted to a Neonatal Care Unit

Introducción. La mayor supervivencia de pacientes prematuros ha modificado la epidemiología de las enfermedades del recién nacido, pero la mortalidad neonatal aún es el principal componente de la mortalidad infantil. El objetivo del estudio fue cuantificar la mortalidad neonatal y los factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales. Material y métodos. Estudio de cohorte prospectivo realizado de enero de 2016 a enero de 2017 en el Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Se cuantificó la incidencia de muertes y las condiciones asociadas mediante un análisis multivariado con regresión logística. Resultados. Se registraron 9366 nacidos vivos; fueron internados en la Unidad de Cuidados Neonatales el 15% (n: 1410). La mortalidad fue de 125,5 por 1000 recién nacidos internados (IC 95%: 109-144); las principales causas fueron malformaciones o enfermedades genéticas (28,2%), infecciones (24,9%) y síndrome de dificultad respiratoria (20,9%). Las condiciones asociadas a muerte fueron edad gestacional < 37 semanas (OR 2,41; IC 95%: 1,49-3,93), peso al nacer < 1500 gramos (OR 6,30; IC 95%: 4,159,55), dificultad respiratoria moderada/grave a los 10 minutos de vida (OR 1,89; IC 95%: 1,242,86), Apgar < 7 a los 5 minutos de vida (OR 9,40; IC 95%: 5,76-15,31), malformaciones congénitas (OR 5,52; IC 95%: 3,12-9,78) y menos de cinco consultas de control prenatal (OR 1,51; IC 95%: 1,09-2,08). Conclusiones. El nacimiento prematuro, bajo peso al nacer, dificultad respiratoria, Apgar < 7, malformaciones congénitas y antecedente de < 5 consultas de control prenatal se asociaron con mayor riesgo de muerte.

Introduction. The increasing survival rate of preterm infants has altered the epidemiology of neonatal diseases; however, neonatal mortality is still the main component of child mortality. The objective of this study was to evaluate neonatal mortality and associated factors in newborn infants admitted to a neonatal care unit. Material and methods. Prospective cohort study conducted between January 2016 and January 2017 at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca." The incidence of deaths and associated conditions was evaluated using a multivariate logistic regression analysis. Results. A total of 9366 live births were registered; 15% (n: 1410) of these were admitted to the neonatal care unit. The mortality rate was 125.5 per 1000 hospitalized newborn infants (95% confidence interval --#91;CI--#93;: 109-144); the main reasons for admission were congenital malformations or genetic disorders (28.2%), infections (24.9%), and respiratory distress (20.9%). The conditions associated with death were gestational age < 37 weeks (OR: 2.41, 95% CI: 1.49-3.93), birth weight < 1500 grams (OR: 6.30, 95% CI: 4.15-9.55), moderate/severe respiratory distress at 10 minutes (OR: 1.89, 95% CI: 1.24-2.86), Apgar score < 7 at 5 minutes (OR: 9.40, 95% CI: 5.76-15.31), congenital malformations (OR: 5.52, 95% CI: 3.12-9.78), and less than 5 antenatal care visits (OR: 1.51, 95% CI: 1.09-2.08). Conclusions. Preterm birth, low birth weight, respiratory distress, Apgar score < 7, congenital malformations, and a history of < 5 antenatal care visits were associated with a higher risk for death.

Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center / Sobrevida hospitalar após a alta de neonatos doentes transportados por ambulância terrestre ou aérea para um centro terciário

Abstract Objective: To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Methods: Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. Results: A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5 km) than by ground (median: 11.3 km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance.

Resumo Objetivo: Avaliar as diferenças na sobrevida hospitalar entre os modos de transporte para um centro terciário na Colômbia para neonatos gravemente doentes. Métodos: Estudo observacional de neonatos gravemente doentes transportados por ar ou terra que precisam de cuidados médicos em um centro que oferece serviços altamente complexos. Foram coletados dados sociodemográficos, clínicos, sobre o Índice de Risco da Estabilidade Fisiológica no Transporte (TRIPS) e o meio de transporte. Os pacientes foram descritos e submetidos a uma análise bivariada e a variável dependente foi a condição (vivo ou morto) no momento da alta. Uma regressão múltipla de Poisson com modelo de variância robusta foi usada para ajustar as associações. Resultados: Foram transportados 176 neonatos por ambulância (10,22% pelo ar) ao longo de seis meses. As distâncias foram maiores pelo ar (mediana: 237,5 km) do que por terra (mediana: 11,3 km). A mortalidade foi mais alta entre neonatos transportados pelo ar (33,33%) do que por terra (7,79%). Não foram encontradas diferenças na sobrevida entre os dois grupos após o ajuste com o modelo múltiplo. Foi observada uma interação entre o meio de transporte e a distância. A alta hospitalar com vida foi associada à gravidade clínica na internação, ao peso ao nascer, à hemorragia durante o terceiro trimestre e aos níveis de potássio sérico na internação. Conclusões: O meio de transporte não foi associado ao resultado. Na Colômbia, o acesso a serviços médicos por transporte aéreo é uma boa opção para neonatos em condições críticas. Estudos adicionais determinariam a distância ideal (tempo de transporte) para obter bons resultados clínicos de acordo com o tipo de ambulância.

Nutritional management and postoperative prognosis of newborns submitted to primary surgical repair of gastroschisis / Manejo nutricional e prognóstico pós-operatório do recém-nascido submetido à correção cirúrgica primária de gastrosquise

Abstract Objective Gastroschisis is a defect of the abdominal wall, resulting in congenital evisceration and requiring neonatal intensive care, early surgical correction, and parenteral nutrition. This study evaluated newborns with gastroschisis, seeking to associate nutritional characteristics with time of hospital stay. Methods This was a retrospective cohort study of 49 newborns undergoing primary repair of gastroschisis between January 1995 and December 2010. The newborns’ characteristics were described with emphasis on nutritional aspects, correlating them with length of hospital stay. Results The characteristics that influenced length of hospital stay were: (1) newborn small for gestational age (SGA); (2) use of antibiotics; (3) day of life when enteral feeding was started; (4) day of life when full diet was reached. SGA infants had longer length of hospital stay (24.2%) than other newborns. The length of hospital stay was increased by 2.1% for each additional day taken to introduce enteral feeding. However, slower onset of full enteral feeding acted as a protective factor, decreasing length of stay by 3.6%. The volume of waste drained by the stomach catheter in the 24 h prior the start of enteral feeding was not associated with the timing of diet introduction or length of hospital stay. Conclusion Early start of enteral feeding and small, gradual increase of volume can shorten the use of parenteral nutrition. This management strategy contributes to reduce the incidence of infection and length of hospital stay of newborns with gastroschisis.

Resumo Objetivo A gastrosquise é uma malformação da parede abdominal que resulta em evisceração congênita e requer tratamento intensivo neonatal, correção cirúrgica precoce e nutrição parenteral. Investigaram-se neste estudo os recém-nascidos com gastrosquise e procurou-se correlacionar as suas características nutricionais com o tempo da internação hospitalar. Métodos Estudo de coorte retrospectivo de 49 recém-nascidos submetidos à correção primária de gastrosquise de janeiro de 1995 a dezembro de 2010. As características dos neonatos foram descritas com ênfase nos aspectos nutricionais e relacionadas com o tempo de internação hospitalar. Resultados As características que influenciaram a duração da internação foram: 1) recém-nascidos pequenos para a idade gestacional (PIG); 2) uso de antibióticos; 3) dia de vida ao iniciar a dieta enteral; 4) dia de vida ao atingir a dieta plena. Recém-nascidos PIG tiveram maior tempo de internação (24,2%) do que demais neonatos. O tempo de internação foi aumentado em 2,1% para cada dia a mais que se demorou a introduzir a dieta enteral. Entretanto, atingir mais lentamente o aporte pleno da dieta enteral agiu como fator protetor, diminuiu 3,6% no tempo de internação. O volume de resíduo drenado pelo cateter gástrico, nas últimas 24 horas antes do início da dieta enteral, não apresentou correlação com o momento da introdução da dieta nem com a duração da hospitalização. Conclusão Iniciar a dieta enteral precocemente, com aumento gradativo em pequenos volumes, pode abreviar a duração da nutrição parenteral. Esse manejo contribui para a diminuição da incidência de infecções e do tempo de hospitalização de recém-nascidos com gastrosquise.

Supervivencia y morbilidad en recién nacidos de muy bajo peso al nacer en una Red Neonatal sudamericana / Survival and morbidity of very low birth weight infant in a South American Neonatal Network

Objetivo. Analizar la supervivencia y morbilidad relevante según edad gestacional (EG) en recién nacidos de muy bajo peso de nacimiento (RNMBPN) o < 1500 g y, con estos resultados, confeccionar una cartilla para proporcionar información a profesionales de la salud perinatal y padres de prematuros de muy bajo peso. Diseño del estudio. Se utilizaron los datos recogidos prospectivamente de los recién nacidos con peso al nacer de 500 a 1500 g ingresados a 45 centros participantes de la Red Neonatal Neocosur entre enero de 2001 y diciembre de 2011. Resultados. Se analizaron los datos de 8234 RNMBPN con EG entre 24 +0 y 31 +6 semanas. La mortalidad global fue 26% (IC 95% 25,0-26,9), que incluye 2,6% que falleció en sala de partos. Las cartillas de supervivencia y morbilidad para cada semana de gestación se construyeron a partir de los datos obtenidos. La supervivencia al momento del alta aumentó de 29% a las 24 semanas de EG a 91% a las 31 semanas (p < 0,001). La incidencia de morbilidad neonatal relevante se relacionó inversamente con la EG (p < 0,001). Globalmente, 30,8% presentó retinopatía del prematuro; 25%, displasia broncopulmonar; 10,9%, enterocolitis necrotizante; 7,2%, hemorragia intraventricular grave; y 4,6%, leucomalacia periventricular. De los sobrevivientes, 47,3% no presentó ninguna de estas 5 patologías. Conclusiones. Se desarrolló un instrumento de utilidad clínica, con datos regionales actualizados, que determina semana a semana la supervivencia y morbilidad de los RN que nacen entre las 24 +0 y las 31 +6 semanas de EG. Esta información puede emplearse en la toma de decisiones perinatales y en la información parental.

Objective. To analyze survival and relevant morbidity by gestational age (GA) in very low birth weight (VLBW) infants (<1500 g) and, based on these data, develop a fact sheet to provide information to perinatal healthcare providers and very low birth weight preterm infants ́parents. Study Design. Data were prospectively collected in relation to newborn infants with a birth weight between 500 g and 1500 g admitted to 45 sites of the Neocosur Neonatal Network (Red Neonatal Neocosur) between January 2001 and December 2011. Results. Data on 8234 VLBW with a GA between 24 +0 and 31 +6 weeks were analyzed. Overall mortality was 26% (95% CI: 25.0-26.9), including 2.6% of deaths in the delivery room. Fact sheets for survival and morbidity for each week of gestation were developed based on collected data. Survival at discharge increased from 29% at 24 weeks of GA to 91% at 31 weeks of GA (p < 0.001). The incidence of relevant neonatal morbidity was inversely related to GA (p < 0.001). Overall, 30.8% had retinopathy of prematurity, 25% bronchopulmonary dysplasia, 10.9% necrotizing enterocolitis, 7.2% severe intraventricular hemorrhage, and 4.6% periventricular leukomalacia. Among survivors, 47.3% had none of these five conditions. Conclusions. A tool for use in a clinical setting was developed based on updated regional data for establishing week-to-week survival and morbidity of newborn infants born between 24 +0 and 31 +6 weeks of GA. This information could be used to make decisions related to perinatal care and for counseling parents.

Óbito neonatal precoce e tardio: perfil das mães e dos recém-nascidos / Early and late neonatal death: characteristics of mothers and newborn / Muerte neonatal temprana y tardía: características de las madres y de los recién nacidos

O objetivo do estudo foi analisar o perfil das mães e dos recém-nascidos que foram a óbito no período neonatal precoce e tardio. Estudo descritivo-exploratório de corte transversal, que utilizou dados secundários obtidos dos sistemas de informação de mortalidade, de nascidos vivos e prontuários hospitalares de mães residentes em Cuiabá (MT), que deram à luz no ano de 2010. Foram estudados 77 óbitos, sendo que 72,7% ocorreram no período neonatal precoce. Os coeficientes de mortalidade neonatal, precoce e tardio foram, respectivamente, 8,2, 6,0 e 2,2/1.000 nascidos vivos. Não se constatou diferença no perfil materno e dos recém-nascidos que foram a óbito no período neonatal precoce ou tardio. Características que prevaleceram entre os óbitos neonatais foram: realização de menos de 7 consultas pré-natais, prematuridade, baixo peso e Apgar menor que 7 no 1º minuto. Tais resultados indicam a necessidade de investimentos, especialmente na melhoria da qualidade da assistência pré-natal no município.

The aim of the study was to analyze the profile of mothers and newborns who died in the early and late neonatal period. Descriptive, exploratory cross-sectional study that used secondary data obtained from the information systems of mortality, births and hospital records of mothers living in Cuiabá, who gave birth in 2010. We studied 77 deaths, of which 72.7% occurred in the early neonatal period. The early and late neonatal mortality rates were, respectively, 8.2, 6,0 and 2,2/1,000 live births. No difference was found in the profile of mothers and newborns who died in the early or late neonatal period. Characteristics that prevailed among the neonatal deaths were less than 7 prenatal visits, prematurity, low birth weight and Apgar score less than 7 at 1 minute. These results indicate the need for investment, especially in improving the quality of prenatal care in the city.

El objetivo del estudio fue analizar el perfil de las madres y los recién nacidos que murieron en el período neonatal precoz y tardíamente. Estudio exploratorio descriptivo de corte transversal que utilizó datos secundarios obtenidos de los sistemas de información de mortalidad, nacimientos y los registros hospitalarios de las madres que viven en Cuiabá, que dieron la luz en 2010. Se estudiaron 77 muertes, el 72,7% se produjo en el período neonatal temprano. Las tasas de mortalidad neonatal, precoz y tardía, fueron, respectivamente 8,2, 6,0 y 2,2/1.000 nacidos vivos. No hubo diferencias en el perfil materno y de recién nacidos que murieron en el período neonatal temprano o más tarde. Características que prevalecieron entre las muertes neonatales fueron: se realizaron menos de 7 visitas prenatales, partos prematuros, bajo peso al nacer y la puntuación de Apgar inferior a 7 al 1 minuto. Estos resultados indican la necesidad de inversión, sobre todo en la mejora de la calidad de la atención prenatal en la ciudad.

patterns and causes of neonatal mortality at a tertiary hospital in Oman

To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. This is a retrospective cohort study where four years data [January 2006 - December 2009] of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification. The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths [neonatal and post neonatal] at the neonatal intensive care unit was 73 [63 inborn and 10 out born]. Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths [n=58], 34 [59%] were males and 24 [41%] were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% [n=30]. Lethal congenital malformations lead to 17 [29%] newborn deaths, specific diagnosis in 7 newborns [12%], and birth asphyxia in four [7%] of cases. There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Morbimortalidad de recién nacidos con menos de 1500 gramos asistidos en hospitales públicos de la ciudad de Buenos Aires / Mortality and morbidity of very low birth weight newborn infants assisted in Buenos Aires public hospitals

Introducción. La red neonatal de los hospitales públicos porteños desarrolla una estrecha vigilancia de la evolución de los neonatos con menos de 1500 g (RNMBPN), pues contribuyen en gran medida a la morbimortalidad neonatal. Objetivo. Analizar la morbimortalidad de los RNMBPN y determinar la mortalidad ajustada por riesgo utilizando el puntaje de la Red Neonatal de los países del cono sur de América (NEOCOSUR). Material y métodos. Se incluyeron todos los recién nacidos vivos en hospitales de la red con peso de 500-1500 g desde 2008 a 2010. Los datos se registraron prospectivamente con metodología estandarizada. Se calcularon las tasas de mortalidad, morbilidad y la mortalidad ajustada por riesgo según puntaje de NEOCOSUR. Resultados. En el período del estudio nacieron 92 698 niños de los cuales 1,26% pesó menos de 1500 g. Sólo 40,4% recibió corticoides antenatales completos. Un 62,7% desarrolló síndrome de difcultad respiratoria, 5,4% enterocolitis, 10,1% hemorragia endocraneana y 13,4% retinopatía grave. La sepsis precoz fue del 5,6%, la tardía de 9,6%. Un 10,7% presentó displasia broncopulmonar. La mortalidad neonatal fue del 29,2% y la ajustada sin malformados graves, 25,4%. La supervivencia de niños con peso =750 g y edad gestacional =26 semanas fue de 50%. El cociente mortalidad observada/esperada fue de 1,04, con gran variabilidad. Conclusiones. El porcentaje de RNMBP que recibió corticoides antenatales es bajo. La incidencia de sepsis y la proporción de niños con ROP grave son elevadas. La mortalidad ajustada por riesgo es superior a la esperada.

Introduction. The Neonatal Network of Public Hospitals in the city of Buenos Aires closely monitors the progress of newborn infants with a birth weight less than 1500 g (very low birth weight, VLBW) because it largely contributes to neonatal morbidity and mortality. Objective. To analyze the morbidity and mortality of VLBW infants and determine their riskadjusted mortality using the score of the South American Neonatal Network (Red Neonatal de los países del Conosur de América, NEOCOSUR). Material and Methods. Live infants born in the network hospitals with a birth weight of 500-1499 g between 2008 and 2010 were included in the study. Data was recorded prospectively using a standardized methodology. Mortality, morbidity and risk-adjusted mortality rates according to the NEOCOSUR score were estimated. Results. There were 92,698 infants born during the study period. Of them, 1.26% weighed less than 1500 g at birth. Only 40.4% of these received a full course of antenatal corticosteroids. A total of 62.7% of these developed respiratory distress syndrome, 5.4% enterocolitis, 10.1% intracranial hemorrhage, and 13.4% severe retinopathy. Early sepsis was observed in 5.6%, and late sepsis in 9.6%. Bronchopulmonary dysplasia was present in 10.7% of the cases. Neonatal mortality was 29.2%, and the adjusted mortality with no major malformations was 25.4%. Survival of infants with a birth weight of =750 g and a gestational age of =26 weeks was 50%. The observed/expected mortality ratio was 1.04, with a large variability. Conclusions. The percentage of VLBW infants who received antenatal corticosteroids was low. The incidence of sepsis and the rate of infants with severe retinopathy of prematurity are high. The risk-adjusted mortality is higher than expected.

Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo City, Brazil / Escore de Apgar e mortalidade neonatal em um hospital localizado na zona sul do município de São Paulo

Objective: To correlate the Apgar score, and neonatal mortality and its causes at a hospital located in the southern area of São Paulo City. Methods: A retrospective study performed by analysis of medical charts (n=7,094) of all live newborns during the period of 2005 to 2009, with data up to 28 days of life in reference to weight, Apgar score, survival and cause of mortality. Cases were analyzed by the X² test (p < 0.05). Results: In 7,094 births, there were 139 deaths, 58.3% during the first week, and 3.6% of them with Apgar < 4 in the 1st minute. A positive association was found between mortality and this variable, with significantly declining values up to 2,000 g in weight. In the group with weight < 1,000 g, the association with Apgar < 4 in the 1st minute with mortality was three-fold greater than in the 1,000-1,500 g weight group, and 35-fold greater than in the ? 3,000 g group. Among newborns with Apgar 8-10, the rate of mortality and low weight was two times greater than in those with weight > 2,499 g. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. Conclusions: The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.

Objetivo: Correlacionar o escore de Apgar e a mortalidade neonatal e suas causas em um hospital localizado na zona Sul do município de São Paulo. Métodos: Estudo retrospectivo por análise de prontuário (n=7.094), de todos os recém-nascidos vivos, no período de 2005 a 2009, com dados referentes até os 28 dias de vida, quanto a peso, escore de Apgar, sobrevida e causa de mortalidade. Os casos foram analisados pelo teste do X² (p < 0,05). Resultados: Nos 7.094 nascimentos, houve 139 óbitos, 58,3% na primeira semana, 3,6% com Apgar < 4 no 1º minuto. Foi encontrada associação positiva entre mortalidade e essa variável, com valores decrescentes significantemente até o peso de 2.000 g. No grupo de peso < 1.000 g, a associação do Apgar < 4 no 1º minuto com mortalidade foi três vezes maior do que no grupo 1.000 a 1.500 g e 35 vezes maior do que no grupo ? 3.000 g. Entre os recém-nascidos com Apgar de 8 a 10, a mortalidade entre baixo peso foi duas vezes maior do que nos de peso > 2.499 g. O sofrimento fetal e a prematuridade se associaram a óbito neonatal precoce; malformações e o sofrimento fetal à mortalidade tardia. O valor preditivo de morrer quando o Apgar < 4 variou, conforme o peso, entre 62,74% no grupo < 1.000 g a 5,5% no grupo > 3.000 g. Conclusões: O escore de Apgar se mostrou ligado a fatores epidemiológicos e de atenção ao parto, à mortalidade neonatal e se associou a extremo baixo peso.

Hijo de madre adolescente: riesgos, morbilidad y mortalidad neonatal / Risks in adolescent mothers and their children's: morbidity and mortality

Antecedentes: El embarazo en adolescentes es un problema de salud pública por las consecuencias para el binomio madre-hijo. Objetivo: Determinar las características y riesgos en madres adolescentes y sus hijos (antropometría, condición de nacimiento y morbi-mortalidad), en comparación con un grupo de madres adultas control de 20-34 años. Métodos: Estudio de cohorte prospectiva con 379 hijos de mujeres adolescentes y 928 adultas. Los datos fueron analizados empleando mediana, promedio y medidas de dispersión, pruebas t-test no pareado o Wilcoxon rank-sum (Prueba de Mann-Whitney), ANOVA o Kruskall-Wallis, Chi2 o Exacta de Fisher, riesgo relativo y riesgo atribuible a la exposición porcentual con sus intervalos de confianza de 95 por ciento. Resultados: Entre adolescentes hubo mayor número de madres solteras (25,6 por ciento), menor escolaridad y seguridad social en salud (25,9 por ciento) (p<0,05). En adolescentes tempranas hubo más casos de preeclampsia (26,3 por ciento) y trabajo de parto prematuro (10,5 por ciento). Entre madres adolescentes el 30,9 por ciento de los hijos fueron prematuros, y presentaron más patología cardiaca, infecciones bacterianas, sífilis congénita, labio y paladar hendido, y mayor mortalidad, cuando se compararon con hijos de madres adultas (p<0,05). Conclusiones: La maternidad en adolescentes conlleva mayores riesgos de salud para ellas y sus hijos, aumentando la morbilidad, mortalidad, con una perspectiva de exclusión social a lo largo de la vida, pues la mayoría son pobres, con poca educación y madres solteras y sin pareja.

Background: Adolescent pregnancy is a public health problem because of the consequences for mother and child. Objective: To determine the characteristics and risks in adolescent mothers and their children's (anthropometry, birth status, morbidity and mortality) compared with a group of older mothers 20-34 years and control their children. Methods: Prospective cohort study with 379 children and 928 adult female adolescents. Data were analyzed using median, mean and dispersion measures, tests unpaired t-test or Wil-coxon rank-sum (Mann-Whitney test), ANOVA or Kruskal-Wallis, Chi2 or Fisher's exact, relative risk and attributable risk percentage exposure with confidence intervals of 95 percent. Results: Among adolescents there were more single mothers (25.6 percent), lower education and social health insurance (25.9 percent) (p<0.05). In early adolescents were more cases of preeclampsia (26.3 percent) and preterm labor (10.5 percent). Among teenage mothers, 30.9 percent of the children were premature, and had more heart disease, bacterial infections, syphilis, and congenital cleft lip and palate and higher mortality when compared with children of older mothers (p<0.05). Conclusions: Teenage motherhood carries greater health risks to themselves and their children, increasing morbidity, mortality, with a perspective of social exclusion throughout life, as most are poor, poorly educated and single mothers without partner.

A Unidade de Terapia Intensiva Neonatal possibilitando novas práticas no cuidado ao recém-nascido / La Unidad de Terapia Intensiva Neonatal posibilitando nuevas prácticas en el cuidado al recién nacido / The Neonatal Intensive Care Units giving new practices to newborns care

Pesquisa qualitativa, com abordagem sócio-histórica. O objetivo é compreender como se instituíram as práticas de cuidado ao recém-nascido na Unidade de Terapia Intensiva Neonatal (UTIN) em Florianópolis, na década de 1980. O contexto do estudo foi o Hospital Infantil Joana de Gusmão. Os sujeitos foram profissionais de saúde que participaram da implantação da UTIN. Para análise dos dados utilizamos o método genealógico proposto por Foucault. Identificamos quatro agrupamentos discursivos: Muita criança saiu ganhando com isso; A gente aprendeu a cuidar do recém-nascido, cuidando; Faltava um olhar mais científico para a assistência; Cuidado sensível, humanizado e individualizado. A implantação de uma unidade específica para o cuidado do recém-nascido resultou numa redução da morbi-mortalidade neonatal e na aquisição do conhecimento científico. Os discursos dos profissionais de saúde revelam que, desde os primórdios da UTIN, já havia uma preocupação com o cuidado sensível, humanizado e individualizado ao recém-nascido.

Investigación cualitativa, con abordaje socio-histórica, objetivo comprender como se instituyeron las prácticas de cuidado al recién nacido en la Unidad de Terapia Intensiva Neonatal (UTIN) en Florianópolis, Brasil, en la década de 1980. El contexto del estudio fue el Hospital Infantil Joana de Gusmão. Los sujetos fueron profesionales de salud que participaron de la implantación de la UTIN. Para análisis de los datos fue utilizado el método genealógico propuesto por Foucault. Identificamos 4 formaciones discursivas: Muchas niños salieron ganando con eso; Aprendimos a cuidar del recién nacido, cuidando; Faltaba un mirar más científico para la asistencia; Cuidado sensible, humanizado e individualizado. La implantación de una unidad para cuidado del recién nacido resultó en reducción de la morbimortalidad neonatal y adquisición del conocimiento científico. Los discursos de los profesionales de salud revelan que desde los primordios de la UTIN, existía preocupación con el cuidado sensible, humanizado e individualizado al recién nacido.

A qualitative research with a socio-historical approach. The aim is to understand how the established practices of the newborn Intensive Care Units Neonatal (ICUN) in Florianopolis, Brazil, in the 1980's. The study's context was the Child's Hospital Joana de Gusmão. The interviewed for this research were health professionals that had a role in the ICUN implantation. Data analysis was performed using the genealogical method proposed by Foucault. Four discursive groups were identified: Many children won with that; It was learned how to care of newborns; A more scientific view to assistance was lacking; Sensitive, humanized and individualized care. The establishment of a specific unit directed to the newborns resulted in a reduction in the neonatal mortality and scientific knowledge acquisition. The health professionals' speeches reveal that since the beginning of the ICUN, a concern with the sensible, humanized and individualized care with the newborn was present.

Morbilidad en recién nacidos de término en relación a su edad gestacional / Morbidity risk and gestational age among full-term newborns

Introduction: Newborns of Gestational Age (GA) ³ 37 weeks are considered to be full-term, but they might show increased morbidity. Objective: To evaluate morbidity risk between newborns 37-38 weeks GA vs those over 39 weeks. Patients and Methods: Cohort study of all children born at a private clinic in Buenos Aires between January 1, 2006 and July 31, 2007, product of simple pregnancies and without major congenital abnormalities. A total of 1829 children met the criteria, among which 823 (45 percent) were 37-38 weeks GA, and 1006 (55 percent) were 39 weeks or over. The following parameters were recorded: birth route, maternal history and morbidity. Morbidity included at least one of the following: respiratory distress > 2 hours post-birth, use of intravenous solutions, jaundice and use of antibiotics. The association between morbidity and GA was evaluated using Chi-square, and logistical regression was used to evaluate the relationship between newborn morbidity and GA, birth route or maternal hypertension. Results: Newborns of 37-38 weeks GA showed higher incidence of each component of morbidity: respiratory distress (OR = 2,55 IC 95 percent = 1,70-3,82), jaundice (OR = 2,24 IC95 percent 1,72-2,29), antibiotic use (OR = 2,31 IC 95 percent= 1,15-4,69) and IV use (OR = 2,29 IC95 percent = 1,57-3,33). Multivariate analysis showed that GA 37-38 weeks (OR= 1,89 IC95 percent= 1,31-2,71) and a C-section (OR = 1,65 IC95 percent = 1,18-2,32) constituted independent predictors of morbidity. Conclusion: In this experience, a gestational age under 39 weeks increases morbidity risk.

Introducción: A pesar de considerarse recién nacidos (RN) de término a aquellos con edad gestacional (EG) ³ 37 semanas, aún dentro de este grupo, los de menor EG podrían presentar mayor morbilidad. Objetivo: Evaluar si existen diferencias en la frecuencia de morbilidad entre recién nacidos de 37-38 semanas de EG y aquellos de EG ³ de 39 semanas. Pacientes y Método: Estudio de cohorte incluyendo todos los RN de una institución privada de Buenos Aires, nacidos entre 01/01/06 y 31/07/07, con EG ³ 37 semanas, producto de gestas simples y sin malformaciones congénitas mayores (n = 1 829). De ellos, 823 (45 por ciento) tenían EG 37-38 semanas y 1 006 (55 por ciento) EG > 39 semanas. Se registró vía de nacimiento, antecedentes maternos y morbilidad (presencia de al menos una de las siguientes condiciones: dificultad respiratoria > 2 horas del nacimiento, aporte de líquidos intravenosos, ictericia y uso de antibióticos). Se evaluó asociación entre morbilidad (en general y para cada uno de sus componentes) y EG por medio de Chi cuadrado y se utilizó regresión logística para evaluar asociación entre EG, vía de parto (cesárea o vaginal), hipertensión arterial materna y morbilidad. Resultados: Los RN de 37-38 semanas presentaron mayor prevalencia de cada componente de morbilidad: dificultad respiratoria (OR = 2,55 IC 95 por ciento = 1,70-3,82), ictericia (OR = 2,24 IC95 por ciento 1,72-2,29), uso de antibióticos (OR = 2,31 IC 95 por ciento = 1,15-4,69) y accesos vasculares (OR = 2,29 IC95 por ciento = 1,57-3,33). El análisis multivariado mostró que EG 37-38 semanas(OR= 1,89IC95 por ciento= 1,31-2,71) y el parto por cesárea (OR = 1,65 IC95 por ciento = 1,18-2,32) constituían predictores independientes de morbilidad. Conclusión: En recién nacidos de término, la EG < 39 semanas incrementa la morbilidad.

Fatores preditores para o óbito neonatal em gestações com diástole zero ou reversa na doplervelocimetria da artéria umbilical / Predictor parameters of neonatal death in gestations with absent or reverse end-diastolic flow in the umbilical artery doppler velocimetry

OBJETIVO: avaliar os fatores de risco antenatais e pós-natais para o óbito neonatal em gestações com diástole zero (DZ) ou reversa (DR) na doplervelocimetria da artéria umbilical. MÉTODOS: estudo transversal, retrospectivo, inferencial, a partir de 48 prontuários de gestações únicas com DZ ou DR, idade gestacional entre 24 e 34 semanas, em uma maternidade no Nordeste do Brasil. A média de idade foi de 27,3 anos (DP: 7,9). Vinte (41,7 por cento) eram primigestas. Síndromes hipertensivas foram observadas em 44 (91,7 por cento) casos. Trinta e cinco (72,9 por cento) apresentavam DZ e 13 (27,1 por cento) DR. Procedeu-se inicialmente à análise univariada (teste t de Student e teste Exato de Fisher), relacionando os parâmetros com o desfecho avaliado (óbito neonatal). As variáveis que apresentaram associação significativa foram incluídas no modelo de regressão logística (Estatística de Wald). O nível de significância utilizado foi de 5 por cento. RESULTADOS: a mortalidade perinatal foi de 64,6 por cento (31/48). Ocorreram cinco óbitos fetais e 26 neonatais. A média de idade gestacional no momento do diagnóstico foi de 27,9 (DP: 2,8) semanas. A resolução da gestação antes de 24 horas após o diagnóstico ocorreu em 52,1 por cento dos casos. Parto abdominal foi realizado em 85,4 por cento dos casos. Os recém-nascidos pesaram em média 975,9 g (DP: 457,5). Vinte e quatro (57,1 por cento) apresentaram Apgar menor que 7 no primeiro minuto e 21,4 por cento, no quinto. A idade gestacional no momento do diagnóstico, o peso ao nascer e o Apgar de primeiro minuto revelaram-se variáveis significativamente relacionadas com o óbito neonatal (valores de p foram, respectivamente, 0,008; 0,004 e 0,020). As razões de chance foi de 6,6; 25,3 e 13,8 para o óbito neonatal, quando o diagnóstico foi estabelecido até a 28ª semana, peso <1000 g e Apgar < 7, respectivamente. CONCLUSÕES: idade gestacional no momento do diagnóstico, peso ao nascer e Apgar de primeiro minuto foram fatores capazes de predizer o óbito neonatal em gestações com DZ ou DR na doplervelocimetria da artéria umbilical.

PURPOSE: to evaluate the antenatal and postnatal risk factors of neonatal death in pregnancies with absent (DZ) or reverse (DR) end-diastolic flow in the umbilical artery. METHODS: a cross-sectional retrospective study based on data from 48 medical records of singleton pregnancies with DZ or DR, and gestational age of 24 to 34 weeks, at a maternity in the Brazilian Northeast. Mean age was 27.3 (SD: 7.9) years. Twenty (41.7 percent) patients were primiparas. Hypertensive disorders were found in 44 (91.7 percent) cases. Thirty-five women (72.9 percent) had DZ and 13 (27.1 percent) had DR. Univariate analysis was firstly done (Student's t-test and Fisher's exact test) correlating the parameters with the assessed outcome (neonatal death). Variables that showed significant association were included in the logistic regression model (Wald statistics). The level of significance was set at 5 percent. RESULTS: The perinatal mortality rate was 64.6 percent (31/48). There were five stillbirths and 26 neonatal deaths. The mean gestational age at diagnosis was 27.9 (SD: 2.8) weeks. Deliveries before 24 hours after diagnosis occurred in 52.1 percent of the cases. Cesarean section was performed in 85.4 percent of the sample. The newborns weighed 975.9 g on average (SD: 457.5). Twenty-four (57.1 percent) presented Apgar scores below 7 in the first minute and 21.4 percent in the fifth minute. Gestational age at diagnosis, birth weight and Apgar of the first minute proved to be variables significantly related to neonatal death (p values were: 0.008, 0.004, and 0.020, respectively). The Odds Ratio was 6.6, 25.3 and 13.8 for neonatal death, when the diagnosis was established at the 28th week, weight was <1000 g and first minute Apgar score was <7, respectively. CONCLUSIONS: gestational age at diagnosis, birth weight and Apgar score at the first minute were factors that could predict neonatal death in pregnancies with DV or DR determined by umbilical artery Doppler velocimetry.

Sobrevida de neonatos de extremo bajo peso al nacer en una región del sur de Chile / Survival in extremely low birth weight infants in a region of southern of Chile

Objetivo: Caracterizar la sobrevida y factores asociados en prematuros de extremo bajo peso al nacer (EBPN). Método: Cohorte de 93 neonatos <1000g ingresados entre 2000-2005 a cuidado intensivo neonatal del Hospital Clínico Regional de Valdivia, Chile, seguidos hasta su egreso. Se calculó la sobrevida mediante método de Kaplan-Meier, evaluándose su relación con el peso al nacer (PN), edad gestacional (EG), adecuación PN-EG, Apgar, administración de corticoides prenatales (CPN)y surfactante, comparando curvas de sobrevida con la prueba Log-Rank. Resultados: La sobrevida global fue 64,5 por ciento, variando por PN desde 33 por ciento (<600g) a 87 por ciento (900-999g) y por EG desde nula sobrevida (<24 semanas) hasta 100 por ciento (>30 semanas). Las muertes ocurrieron principalmente en período neonatal (97 por ciento), las principales causas fueron: hemorragia pulmonar (21,2 por ciento), enfermedad de membrana hialina (18,2 por ciento) y prematuridad extrema (18,2 por ciento). Se estimó mayor probabilidad de sobrevida a mayor PN y EG, observándose diferencias significativas al comparar los grupos 800-899g vs. 900-999g y <25 semanas vs. 25-26 semanas. La administración de CPN se asoció significativamente a mejor sobrevida pero sin diferencias respecto del número de dosis. La mejor puntuación Apgar minuto y cinco minutos se asoció a mejor sobrevida. No hubo diferencias globales por categorías de PN y EG con el uso de surfactante, sexo y condición pequeño para la EG. Conclusiones: Actualmente, la sobrevida de niños de EBPN de nuestro medio comienza en 24 semanas, mejorando considerablemente con mayor EG. Consecuentemente, se requieren estrategias para evitar el parto prematuro o extender la oportunidad del parto en casos de riesgo materno-fetal.

Objective: To characterize the survival and its related factors in extremely low birth weight infants (ELBW). Methods: Cohort of 93 premature infants weighing <1000g admitted at the NICU of the Clinical Regional Hospital from Valdivia, Chile, between 2000 and 2005, and followed until the discharge. Survival was estimated using Kaplan-Meier method, evaluating its relation with birth weight (BW), gestational age (GA), relation BW-GA, Apgar score, antenatal corticosteroid administration (ANC) and surfactant administration, comparing survival curves through Log-Rank test. Results: Overall survival was 64.5 percent, varying by BWfrom 33 percent (<600g) to 87 percent (900-999g), and by GA from null survival (<24 weeks) to 100 percent (>30 weeks). Deaths occurred mainly in neonatal period (97 percent), highlighting pulmonary hemorrhage (21.2 percent), hyaline membrane disease (18.2 percent) and extreme prematurity (18.2 percent) as the most important causes of death. Higher survival probability with greater BW and GA was found, detecting significant differences when comparing the groups of 800-899g versus 900-999g and between <25 weeks of gestation and 25-26 weeks. The use of ANC was significantly associated with better survival, but the number of doses administered was not related with the survival. Also, the best Apgar score at the minute and five minutes were associated with better survival. In overall analyses or by categories of BW and GA, gender, surfactant administration, and the condition of small for GA, were not associated with the survival. Conclusions: Nowadays, survival of Chilean ELBW infants begins in 24 weeks improving with greater GA. Consequently, strategies are required to avoid the premature birth or to extend the opportunity of the delivery in cases of maternal-fetal risk.

Principais causas de óbitos infantis pós-neonatais em Belo Horizonte, Minas Gerais, Brasil, 1996 a 2004 / Leading causes of post-neonatal infant deaths in Belo Horizonte, State of Minas Gerais, Brazil, 1996 to 2004

OBJETIVOS: analisar a evolução das principais causas de mortes infantis pós-neonatais em Belo Horizonte, Minas Gerais, Brasil, entre 1996 e 2004. MÉTODOS: as causas de morte foram agrupadas pelos capítulos e por lista condensada da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, 10ª revisão - (CID-10). As diarréias, pneumonias, desnutrição e septicemia foram analisadas como grupamento específico de causas evitáveis. Taxas e mortalidade proporcional por causa foram calculadas para períodos trienais. RESULTADOS: foram registrados 2010 óbitos pós-neonatais no período, com tendência decrescente. A taxa de mortalidade infantil passou de 26,6 para 13,3/1000 nascidos vivos (NV), e a pós-neonatal de 8,6 para 4,3/1000 NV de 1996 a 2004, com maior redução nas taxas por doenças respiratórias e doenças infecciosas. Apesar do decréscimo, o grupamento diarréia-pneumonia-desnutrição-septicemia ainda foi responsável por cerca de um quarto dos óbitos em 2002-2004. As malformações congênitas passaram a representar a principal causa de morte pós-neonatal no último triênio e, juntamente com as afecções perinatais, representaram 34 por cento dos óbitos. Observou-se ainda aumento da proporção de óbitos por causas mal definidas e por causas externas. CONCLUSÕES: foram observadas mudanças importantes do perfil de causas de mortalidade pós-neonatal em Belo Horizonte, com aumento da participação das malformações congênitas e afecções perinatais. Esse aumento provavelmente se deveu ao deslocamento de óbitos neonatais para o período pós-neonatal.

OBJECTIVES: to analyze the evolution of the leading causes of post-neonatal mortality by underlying cause of death in the city of Belo Horizonte, Minas Gerais Brazil, between 1996 and 2004. METHODS: causes of death were grouped according to the chapters of the International Statistical Classification of Diseases and Related Health Problems, 10th review (ICD-10) and an abbreviated ICD-10 list. Diarrhea, pneumonia, malnutrition and septicemia were analyzed in a specific group for avoidable causes. Rates and proportional mortality by cause were calculated for three-year periods. RESULTS: 2,010 post-neonatal deaths were registered in the period, and the tendency was for the number to decrease. Infant mortality rate dropped from 26.6 to 13.3/1000 live births (LB), and post-neonatal from 8.6 to 4.3/1000 LB between 1996 and 2004. Mortality rates from both respiratory and infectious diseases were down 60 percent. However, the diarrhea-pneumonia-malnutrition-septicemia group was still responsible for a quarter of all deaths in 2002-2004. Congenital malformations have become the leading post-neonatal cause of death, along with perinatal conditions, responsible for 34 percent of deaths. In addition, an increase in the proportion of mortality accounted for by injuries and ill-defined causes was observed. CONCLUSIONS: a change was observed in the profile of the causes of post-neonatal mortality in Belo Horizonte, with an increase in the risk of death from congenital anomalies and perinatal conditions. This increase may be a consequence of displacement of neonatal deaths to the postneonatal component.

Profile of neonates admitted in pediatric ICU and validation of Score for Neonatal Acute Physiology (SNAP).

A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital in northern India to profile neonatal admissions and to assess the validity of the Score for Neonatal Acute Physiology (SNAP) in predicting the outcome in terms of mortality and length of hospital stay (LOS). Neonatal sepsis (51%) and birth asphyxia (11.2%) were the commonest indications for admission. Thirty-seven (38.1%) of the neonates died. The mean SNAP score in babies who died was 18.8 +/- 9.8 and 10.1 +/- 6.4 in survivors (P<0.001). There was no correlation between SNAP score and mean length of stay in hospital (P=0.5). We conclude that SNAP correlates well with mortality in neonates admitted to the PICU.

Mortalidade infantil e alguns indicadores demográficos da população indígena do Distrito Sanitário Especial Indígena do Leste de Roraima, Brasil, 2002 a 2004 / Infant mortality and demographic indicator of the indigenous population of the Native Special Sanitary District of the East of Roraima, Brazil, 2002 to 2004

O objetivo deste estudo é descrever o perfil de mortalidade e outros indicadores demográficos, dando maior enfoque à descrição da mortalidade infantil e seus componentes neonatal e pós-neonatal, de uma população indígena atendida pelo Distrito Sanitário Especial Indígena do Leste do Estado de Roraima. A população é estimada em 31.000 habitantes, com cerca de seis grupos étnicos (Macuxi, Wapixana, Taurepang, Ingaricó, Patamona, Wai-Wai). As fontes de dados utilizadas são oriundas dos boletins de nascimento, óbito e de estimativas populacionais no período compreendido de 2002 a 2004. A população apresentou uma composição etária predominantemente de jovens, onde 52 por cento da população tinham menos de 15 anos de idade. Observaram-se taxas brutas de natalidade e de mortalidade de 42,1 nascimentos e 5,2 óbitos por mil habitantes. A mortalidade infantil foi 50,0 por mil nascidos vivos. Foi observado que 47 e 42 por cento do total de óbitos em menores de 1 ano estavam concentrados nos componentes neonatal precoce e pós-neonatal, respectivamente. A taxa de mortalidade perinatal observada foi de 38,9 crianças por mil nascimentos. A primeira causa de óbito registrada é relacionada a algumas afecções originadas no período perinatal seguidas das doenças respiratórias. Ressalta-se ser de fundamental importância o desenvolvimento de estudos direcionados à análise de dados sobre eventos vitais, com enfoque sobre os principais elementos da dinâmica populacional indígena no sentido de viabilizar planejamentos mais adequados às ações de saúde.