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- ItemAcesso aberto (Open Access)Early neonatal deaths associated with perinatal asphyxia in infants >= 2500 g in Brazil(Soc Brasil Pediatria, 2017) Branco de Almeida, Maria Fernanda [UNIFESP]; Kawakami, Mandira Daripa [UNIFESP]; Oliveira Moreira, Licia Maria; Vaz dos Santos, Rosa Maria; Anchieta, Leni Marcia; Guinsburg, Ruth [UNIFESP]Objective: To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing >= 2500 g in Brazil from 2005 to 2010. Methods: The population study enrolled all live births of infants with birth weight >= 2500 g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases, 10th Revision (P20.0, P21.0, and P24.0). An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year. Results: A total of 10,675 infants weighing >= 2500 g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24 h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38%) of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (p < 0.001); the meconium aspiration syndrome-specific early neonatal mortality ratio remained between 0.20 and 0.29 per 1000 live births during the study period. Conclusions: Despite the decreasing rates in Brazil from 2005 to 2010, early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight andwithout congenital malformations are still high, and meconium aspiration syndrome plays a major role. (c) 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.
- ItemSomente MetadadadosEpidemiologia dos óbitos neonatais hospitalares associados à asfixia perinatal em Maceió, Alagoas, 2009(Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Oliveira, Junko Asakura Bezerra de [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Alagoas has the highest infant and neonatal mortality rates among all the States of Brazil and thus it urges to know its determinants. Aim: to describe the epidemiology of neonatal mortality associated with asphyxia in public maternity hospitals, besides the infra-structure of neonatal assistance, in Maceió, capital of Alagoas State, in 2009. Methods: This is a cross-sectional study with daily active search for medical records of mothers and their newborns who died under 28 days of age in 8 public maternity hospitals in Maceió, from Jan/1st until Dec/31st 2009. Death was considered associated with asphyxia if, at least, one criteria was present: Apgar score <6 at 5 minutes; meconium aspiration syndrome (MAS); hypoxic-ischemic encephalopathy; Apgar score <3 in the 1st minute with ventilation at birth; death record of hypoxia/asphyxia at birth. Patients with major malformations, birth weight <400g or gestational age <22 weeks were excluded. Descriptive analysis of patients included the variables of location and condition of birth and death, morbidity and therapeutic interventions. Information on physical structure, material and human resources were collected from hospitals in March and September/09. Results: In 2009, in the eight public maternity hospitals 20860 babies were born and there were 326 neonatal deaths, of which 243 (74%) were preventable. Asphyxia was present in 113 (46%) cases, of which 15 died without intensive care and 24 came from others institutions. Out of 113 deaths, 12 did not receive any resuscitation procedures and nine of them were 22-27 weeks old. Out of 86 low birth weight newborns, 79 (92%) were born with obstetrician and pediatrician care, 75 (87%) developed respiratory distress syndrome, 41 (48%) received surfactant and 41 had neonatal sepsis. Ten (37%) of the group with birth weight >2500g (27 newborns) were born without obstetrician nor pediatrician care and 17 (68%) had meconium aspiration syndrome. Regarding the interventions, 7 did not receive mechanical ventilation, 19 (70%) received aminas and only 2 had monitored blood pressure. Out of 113 deaths, 42% died before 24h and 42% between 2 and 6 days after birth. The death registration referred asphyxia in 37% of the cases and necropsy was performed in 4 cases. In the eight public maternity hospitals, where there were born 1 to 12 newborns, the number of resuscitation tables ranged from 1 to 3. Four public maternities had physical infrastructure, material and equipment for neonatal resuscitation in the delivery room. There were pediatricians all the time in seven maternities; 62% of the pediatricians attended a neonatal resuscitation course in the last two years. Out of the nursing staffs, 49% attended to the course, but one staff had never attended one. The physical infrastructure, material and equipment did not change along the year. Conclusion: In the City of Maceio, in 2009, asphyxia at birth was presented in half of the neonatal death in-hospital. In the majority of the cases there were pediatricians in the delivery room, mainly in the low birth weight cases. There were neonatal deaths in intermediate care units, and it shows the frailty of physical infrastructure and equipments, associated to the severity at birth.
- ItemAcesso aberto (Open Access)Epidemiologia dos óbitos neonatais hospitalares associados à asfixia perinatal no interior do Estado de Alagoas em 2009(Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Silva, Cicero José da [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To describe epidemiologic frequency and characteristics of intra-hospital neonatal deaths associated to perinatal asphyxia in the country side of Alagoas state in 2009. Method: Prospective cross-seccional study with weekly active search for medical records of mothers and their newborn infants who died before 28 days of age from January 1st to December 31, 2009, in 11 maternity hospitals from 7 towns which account for 67% of newborn births in the country side of Alagoas. This study was approved by the Research Ethics Committee as well as by all the 11 maternity hospitals. It was considered death associated to perinatal asphyxia if at least one of these criteria was found: Apgar score <6 in the 5th minute; meconium aspiration syndrome (MAS); hypoxic-ischemic encephalopathy; Apgar score <3 in the 1st minute with ventilation at birth; death record of hypoxia/asphyxia at birth in the Declaration of Death. Patients with major malformations, birth weight <400g or gestational age <22 weeks were excluded. Descriptive analysis of patients included the variables of location and condition of birth and death, morbidity and therapeutic interventions. Information on physical structure, material and human resources were collected from hospitals in March and September/09. Results: In 2009, in 11 hospitals were registered 19,740 live births and 173 neonatal deaths, 155 were preventable, of which 100 (65%) had birth asphyxia (5.1 deaths per thousand live births) and 91% occurred at the same hospital of birth. Obstetrician and pediatrician were present, respectively, in 83% and 91% of the births of the 53 infants with low birth weight and 77 and 79% of 47 infants 2500g. Apgar score 3 in the 1st minute occurred in 83% of the 53 low birth weight newborn and 1/3 of them had no improvement at 5 minutes score; 92% developed respiratory distress, 46% received surfactant, 70% mechanical ventilation and 73% remained in incubator. Of the 61 infants >2500g, 47(77%) had asphyxia, half of them had 1st minute Apgar score 3 and 17% of whom remained unchanged at 5 min. MAS was clinically diagnosed in 59% of this group, 59% received mechanical ventilation and 56% remained in the incubator. Died outside environment intensive care 34% of low birth weight newborn infants and 62% of 2500g. Death occurred within 24 hours in 41% and between 2 and 6 days in 47% of the 100 newborn infants. Half of death certificates contained reference to asphyxia and no autopsy was performed. In March/2009, in each hospital there was a single neonatal resuscitation table for reception at birth and 7 had complete material for manual ventilation. In evaluating September/09, all tables had material for resuscitation. Two hospitals had neonatal ICU beds and 4 had care intermediate. Between 2007 and 2009, 58% of pediatricians and 25% of staff nursing had done neonatal resuscitation training course. Conclusion: The rate of neonatal deaths with birth asphyxia in the interior of Alagoas is very high (65%), especially in newborns weighing over 2,500g, identifying inadequate conditions of care in delivery rooms and in neonatal care units.
- ItemAcesso aberto (Open Access)Fatores periparto associados a necessidade de reanimação em sala de parto de RN de peso ≥ 2.500g em maternidades públicas de nível terciário do Ceará, Brasil(Universidade Federal de São Paulo (UNIFESP), 2014) Sousa, Jose Roberto Pereira [UNIFESP]; Guinsburg, Ruth [UNIFESP]; http://lattes.cnpq.br/6286661930160341; http://lattes.cnpq.br/8077242632888955; Universidade Federal de São Paulo (UNIFESP)Objetivo: Avaliar os fatores periparto associados a necessidade de reanimacao neonatal em sala de parto em recem-nascidos com peso ao nascer ≥2.500g sem malformacoes congenitas, em maternidades publicas de referencia do estado do Ceara. Metodos: Caso-controle retrospectivo de base hospitalar e multicentrico. Os casos foram recem-nascidos com peso ao nascer ≥2500g sem malformacoes que necessitaram de ventilacao com pressao positiva em sala de parto e/ou apresentaram Boletim de Apgar de 5º minuto inferior a sete, nascidos nas maternidades publicas de referencia do Estado do Ceara-Brasil, no periodo de Marco/2009 a Marco/2010. O grupo controle foi selecionado entre os nascidos vivos no mesmo periodo com Apgar no 1º minuto ≥ 8 e que nao realizaram qualquer manobra de reanimacao, pareado com o caso por sexo, peso ao nascer (mais ou menos 100g), idade gestacional (mais ou menos 7 dias) e epoca de nascimento (a mais proxima). Foram estudadas as caracteristicas demograficas maternas e a morbidade materna antenatal, as caracteristicas do parto e a morbidade intraparto e as caracteristicas do atendimento obstetrico ao trabalho de parto e parto. As variaveis associadas a necessidade de reanimacao neonatal em sala de parto e/ou a apresentacao de Boletim de Apgar de 5º minuto inferior a sete foram determinadas pela regressao logistica multivariada condicional, com os resultados expressos por odds ratio (OR) e IC95%. Resultados: Dos 2.233 nascidos vivos com peso ≥ 2.500g com Apgar ≤ 7 no 1º minuto e/ou <7 no 5º minuto e sem malformacao congenita, 399 receberam ventilacao com pressao positiva, 8 foram submetidos a ventilacao e massagem cardiaca e/ou medicacoes e, em 33, nao havia anotacao de manobras de reanimacao, mas o Apgar de 5º minuto permaneceu menor do que sete. Assim, 435 casos e a mesma quantidade de controles foram analisados. A regressao logistica condicional para o uso de ventilacao com pressao positiva em sala de parto e/ou Boletim de Apgar de 5º minuto inferior a sete mostrou sua associacao com idade gestacional <37 semanas (OR 4,35; IC95%: 1,44-13,20), liquido amniotico meconial (8,54; 4,18-17,43), gestante transferida de outro hospital (1,68; 1,00-2,81), realizacao de exame de avaliacao da dilatacao cervical na admissao (0,59; 0,40-0,86) e realizacao de partograma (0,70; 0,48-1,00). Conclusao: Os resultados revelam falhas importantes na assistencia obstetrica associadas a organizacao do sistema de referencia, efetivacao de protocolos de assistencia obstetrica ao parto e intraparto
- ItemAcesso aberto (Open Access)Índice de Apgar 0 a 3 no 1º e 5º minuto e evolução para óbito infantil: estudo populacional no Estado de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2011-06-29) Viau, Angela Cristina [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To determine the incidence and the infant mortality in newborns with Apgar score 0-3 at both 1 and 5 minutes of life, moreover to identify demographic characteristics associated with infant death. Study Design: cohort study population in the State of Sao Paulo, Brazil collected from the database of Fundacao Seade, consisted of the Certificates of Live Births in 2006 and 2007, and the Certificates of Death from 2006 to 2008, by linking deterministic method. Included were live births without congenital malformations with Apgar score 0-3 at both 1 and 5 minutes of life, confirmed in the original Certificates of Births and/or medical records. Logistic regression was applied to determine the demographic variables present at birth associated with infant death. Results: 1,639 of 1,027,132 live births (1,6/1,000) met study criteria. The infant mortality was 70%. Of 1,075 neonatal deaths, 880 (82%) occurred within 24 hours, of which 477 in the first hour of life. The outcome to infant death was 615 (95%) of newborns with Apgar score 0 or 1 and 532 (54%) with 2 or 3 Apgar score at 5 minutes of life. Of the 25 survivors (median birth weight 3.100g) with Apgar scores of 0 at 1 and 5 minutes of life, half of them had neurological abnormalities during hospitalization. Among the 357 infants with a gestational age of 22-27 weeks and Apgar score 0 or 1 at 5 minutes, the only survivor had neurological abnormalities. In the 235 newborns with birth weight . 2500g and in the 627 premature infants with gestational ages between 22-27 weeks with Apgar score 0-3 at both 1 and 5 minutes who died, 81 (35%) in the first group and 480 (77%) in the second did not show diagnosis of intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome in any line of the Certificate of Death. In the population of newborns with Apgar 0-3 at both 1 and 5 minutes, the independent variables associated with infant death were the Apgar score 0 or 1 at 5 minutes (OR 16.61; 95% CI 11.13 to 24.79), low birth weight (OR 7.52; 5.72 to 9.87), birth in outside the capital (OR 1.74; 1.30 to 2.33) in nonpublic hospital (OR 1.55; 1.18 to 2.04) and at night (OR 1.31; 1.002 to 1.71). Conclusion: This population cohort study showed high infant mortality, predominantly in the first 24 hours after delivery, associated with Apgar score 0 or 1 at 5 minutes of life and low birth weight.
- ItemAcesso aberto (Open Access)Mortalidade neonatal associada à asfixia perinatal no estado de São Paulo : série histórica de 2004 a 2013(Universidade Federal de São Paulo (UNIFESP), 2017-12-05) Kawakami, Mandira Daripa [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; http://lattes.cnpq.br/7346149704101984; http://lattes.cnpq.br/2740685997254275; Universidade Federal de São Paulo (UNIFESP)Objective:To analyze the temporal evolution of the neonatal deaths rate associated with perinatal asphyxia from 2004 to 2013 according to geographical distribution, gestational age (GA) and demographic variables in the State of São Paulo (SP State). Method: Populationbased study including deaths with perinatal asphyxia without congenital anomalies occurred during the first 27 days of life in São Paulo city, in the Metropolitan Area (Capital excluded) and in the countryside of the SP State from 2004 to 2013. Perinatal asphyxia was considered if intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome were written in any line of the original Death Certificate (DC). Data was collected from SEADE Foundation after the linkage of the DC with its respective Birth Certificate based on the deterministic linkage process. The statistics analysis was assessed through Poisson regression model, Kaplan Meier curves, chi-squared test for trend and multivariate Cox regression. Results: From 2004 to 2013, 6,648 deaths resulted from perinatal asphyxia in SSP: 27% in São Paulo city; 21% in the Metropolitan Area (Capital excluded) and 52% in the countryside. The rates of neonatal death with asphyxia in 1,000 live births were 1.16 in 2004 to 0.97 in 2013 in São Paulo city (reduction of 17%; p=0.082); from 1.45 to 0.83 in the Metropolitan Area (reduction of 43%; p<0.001) and from 1.48 to 0.98 ( reduction of 34% ; p<0.001) in the country side. In neonates with 22 to 27 weeks, the reduction rate was higher in the Metropolitan Area than in São Paulo city (p=0.035) and also in neonates from 32 to 36 weeks in the Metropolitan Area (p=0.013) and in the countryside (p=0.003) compared to São Paulo city, with the same reduction rate among the 3 regions for 28-31 weeks and for 37-41 weeks. The median life time until death was 24 hours: higher in São Paulo city (36 hours), followed from the countryside (23 hours) and Metropolitan Area (21 hours). The extreme premature infants had the lowest median time of life (13 hours) and the highest was among the 28-31 weeks (41 hours). Births were more frequent in their hometown, with the reduction of births in SUS hospitals at the Metropolitan Area (p=0.034) and in the countryside (p=0.019), and deaths were more frequent at the same hospital of birth. Teenager mothers were less frequent (p=0.039), with higher rates of primiparous mothers (p<0.001) and cesarean deliveries (p=0.019) and with death reduction among 37-41 weeks (p<0.001) along the ten years. Based on multivariate analysis, adjusting the death year, there was an association of life time to death with: region and birth place, mother’s age, number of prenatal consultations, type of delivery, GA, 1st minute Apgar score, race/colour and sex. Conclusion: Neonatal deaths with perinatal asphyxia reduced significantly during 2004 to 2013, mainly among 32-36 weeks in the Metropolitan Area and in the countryside, most probably due to medical interventions and public policies directed to the pregnant mother and the newborns, which had a great impact in those regions in the State of São Paulo.