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- ItemSomente MetadadadosCusto da sepse neonatal para o Sistema Único de Saúde brasileiro(Universidade Federal de São Paulo (UNIFESP), 2021) Abreu, Mariana Ferreira De Carvalho Westerstahl De [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Universidade Federal de São PauloIntroduction: Neonatal sepsis has an incidence of 1 to 8 cases for every 1000 live births. For those with birth weight <1500g, this incidence is even higher (11 to 25%). Despite advances in the field of perinatology, the average mortality rate is 25%. There are few national data regarding the cost of sepsis and such data involve pediatric and adult patients, but there are no specific data for the neonatal group. Given the scarcity of studies, a better understanding of the costs related to neonatal sepsis may help to assess cost-effective strategies for its prevention and treatment. Objective: To evaluate the hospital cost of hospitalized newborns diagnosed with sepsis in the period 2008 to 2018, from the perspective of the Brazilian Public Health System (Sistema Único de Saúde). Method: Cross-sectional study, with analysis of secondary data from the databases of the Hospital Information System of the Brazilian Public Health System. Infants hospitalized between 0-30 days after birth with a diagnosis of sepsis from 2008 to 2018 were included. The diagnosis used in the study was the one that the hospital considered as the main diagnosis at admission. Costs were analyzed in dollars and reflected only the amount paid by the Brazilian Public Health System to the hospitals for the informed diagnosis upon admission by filling out the hospital admission authorization. The costs were evaluated as the total per admission, and they were compared among Brazilian geographic regions, among etiologic agents, and between neonates with the diagnosis that survived or died. Results: From 2008 to 2018, 47,554 newborns were hospitalized for neonatal sepsis (frequency of 148.04 cases per 100,000 live births), with an average cost of US$ 3,345.59 per hospitalization. Among the Brazilian regions, the average cost of transfer from the Brazilian Public Health System per hospitalization for neonatal sepsis ranged from US$ 2,970.60 in the North region to US$ 4,305.03 in the Midwest region. The highest mean cost was related to hospitalizations for sepsis due to Gram negative agents; the lowest average cost was related to Streptococcus agalactiae sepsis. When comparing the costs of hospitalization between surviving patients and those who died of neonatal sepsis, a higher cost was detected for those who died (t-test; p=0.046). Conclusions: The discussion about neonatal care costs is necessary so that the improvements in the quality of neonatal care may be implemented in a way consistent with the conditions of the country, within the principles of bioethics, guiding the care of newborn infants and their families.
- ItemAcesso aberto (Open Access)Infecção neonatal por Streptococcus agalactiae do grupo B e Escherichia coli(Universidade Federal de São Paulo (UNIFESP), 2020-10-29) Longo, Maria Cristina Barbosa [UNIFESP]; Taminato, Monica [UNIFESP]; http://lattes.cnpq.br/3626639720691828; http://lattes.cnpq.br/4139508415633817; Universidade Federal de São PauloNeonatal sepsis is a major public health issue worldwide and is among the leading causes of morbidity and mortality in neonates, particularly in developing countries. It is an important component in increasing neonatal mortality rates and can lead to serious complications such as morbidity, with long-term impacts for those who survive despite relatively low numbers of cases in this population. Objectives: to verify mortality for early neonatal sepsis and what are the risk factors for neonatal sepsis caused by Streptococcus agalactiae of group B and Escherichia coli and the mortality and prevalence of microorganisms in an intensive care unit in a school hospital. Method: Observational study conducted between 2007 and 2017 with neonates with the diagnosis of clinical and/or laboratory sepsis admitted to the Neonatal Intensive Care Unit of Hospital São Paulo and search for evidence on the main risk factors for infection and neonatal sepsis with a Systematic Review and Meta-analysis, according to the recommendations of Cochrane Collaboration. Results: The results of this work will be presented in the form of two articles. In Article 1 16 were selected to compose the present study. The main risk factors for neonatal infection with GBS and E.Coli are low birth weight and prematurity. In the meta-analysis chart we identified the higher mortality for E.coli and/or GBS sepsis cases, with Odds ratio 3.54 (P < 0.00001). In article 2 181 neonates were included, 36 were excluded from the study because they did not have the complete data in the electronic records. The blood culture positivity rate was 15(10.3%) and there was no positive sample. The mortality rate was 22%. The most prevalent microorganisms were the coagulase-negative Staphylococcus (CONs) with 6(50%), Streptococcus agalactiae with 2(16.6%). Conclusion: In article 1, sepsis by E. Coli presented higher mortality. It was evident that premature and low birth weight newborns have more susceptibility to acquire infection and later sepsis caused by E. Coli and GBS. In article 2, the most prevalent microorganisms found in the study were CONs and GBS among the gram positive and gram negative E.coli bacteria, requiring in addition to specific measures for the prevention of GBS, prevention strategies for the other types of microorganisms that cause infection. In both studies it became evident that more nationwide studies are needed to investigate the etiologies of neonatal sepsis, to map and monitor its local epidemiology in order to carry out public policies with specific measures aimed at this public.