ABSTRACT
Introduction. The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective. To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods. We conducted a descriptive, cross-sectional study. We evaluated the records of Cali's Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results. From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score - five minutes after birth- lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions. We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.
Introducción. El nacimiento de bebés prematuros es un problema de salud pública con gran impacto en la morbimortalidad infantil: cerca del 40 % de las muertes de niños menores de cinco años sucede en el primer mes de vida. Objetivo. Identificar la asociación entre los factores sociodemográficos maternos, el parto prematuro y la mortalidad en recién nacidos menores de 37 semanas en Santiago de Cali, 2017-2019. Materiales y métodos. Se hizo un estudio descriptivo transversal. Se evaluaron los registros de la Secretaría de Salud Pública Municipal de Cali. Se calcularon las razones de probabilidad y los intervalos de confianza (95 %) crudos y ajustados mediante el modelo de regresión logística, en tanto que los datos se procesaron en Stata 16 y los casos se georreferenciaron con el programa QGIS. Resultados. Entre el 2017 y el 2019, los nacimientos de bebés prematuros en Cali correspondieron al 11 %. El control prenatal deficiente aumentó 3,13 veces el riesgo de nacer con menos de 32 semanas (OR ajustado = 3,13; IC95% = 2,75-3,56) y, en madres de municipios fuera de la ciudad, 1,27 veces (OR ajustado = 1,27; IC95% = 1,15-1,41). La mortalidad fue de 4,29 por 1.000 nacidos vivos. Nacer con un peso menor de 1.000 g aumentó el riesgo de mortalidad en 3,42 veces (OR = 3,42; IC95% = 2,85-4,12) y, un puntaje Apgar menor de siete a los cinco minutos del nacimiento, en 1,55 veces (OR=1,55; IC95% = 1,23-1,96). Conclusiones. Se encontró que tener menos de tres controles prenatales, la procedencia de la madre fuera de Cali, ser afrodescendiente y el parto por cesárea, estaban asociados significativamente con la prematuridad de menos de 32 semanas. Hubo mayor mortalidad en los recién nacidos con menos de 1.000 gramos al nacer.
Subject(s)
Social Determinants of Health , Obstetric Labor, Premature , Colombia , Developing CountriesABSTRACT
Breast milk is widely recognized as the best source of nutrition for both full term and premature babies. We aimed to identify clinical results of the implementation of a breast milk bank for premature infants under 37 weeks in a level III hospital. 722 neonates under 37 weeks, hospitalized in the Neonatal intensive care unit (ICU), who received human breast milk from the institution's milk bank 57% (n = 412) vs. mixed or artificial 32% (n = 229), at day 7 of life. An exploratory data analysis was carried out. Measures of central tendency and dispersion were used, strength of association of odds ratio (OR) and its confidence intervals (95% confidence interval (CI)). 88.5% had already received human milk before day 7 of life. Those who received human milk, due to their clinical condition, had 4 times a greater chance of being intubated (OR 4.05; 95% CI 1.80-9.11). Starting before day 7 of life decreases the opportunity to develop necrotizing enterocolitis by 82% (adjusted odds ratio (ORa) 0.18; 95% CI 0.03-0.97), intraventricular hemorrhage by 85% (ORa 0.15; 95% CI 0.06-0.45) and sepsis by 77% (ORa 0.23; 95% CI 0.15-0.33). Receiving human milk reduces the probability of complications related to prematurity, evidencing the importance that breast milk banks play in clinical practice.
