Jornal de Pediatria (Mar 2005)
A mortalidade do prematuro extremo em nosso meio: realidade e desafios Mortality of very low birth weight preterm infants in Brazil: reality and challenges
Abstract
OBJETIVO: Este trabalho apresenta uma revisão da literatura sobre os indicadores epidemiológicos e a estrutura organizacional da assistência perinatal no sistema de saúde brasileiro, enfatizando os aspectos ligados aos neonatos com peso ao nascer OBJECTIVE: The objective of this article is to review and discuss the medical literature on epidemiological indicators and organizational structure of the Brazilian perinatal health system concerning the care of very low birth weight premature infants (< 1,500 g). DATA SOURCES: Electronic search of the MEDLINE, Lilacs and SciELO databases from 1990 to 2004, with a selection made of the most relevant articles. Documents and reports from the Ministry of Health (Mortality Information System - SIM and Live Births Information System - SINASC). SUMMARY OF FINDINGS: The decrease in infant mortality rates and the high incidence of maternal deaths, observed since 1990, prompted de Brazilian government to focus its strategies on the organization and delivery of care to pregnant women and their newborn infants. However, a critical analysis of the actions aimed at the care of premature infants reveals that the coverage and utilization of these services are not uniform and that the records on birth and death rates are not reliable. The availability of neonatal beds is very limited and does not meet the demand, especially for those requiring high levels of complexity. Important challenges must be overcome to adequately deal with the incorporation of inappropriate technology, the limited number of qualified health professionals and utilization of evidence-based best practices to improve perinatal care. CONCLUSIONS: A reduction in the rates of morbidity and mortality of premature infants requires more effective planning and intervention in the prenatal care system. To meet the demand, increases in the number of neonatal intensive care beds should be implemented through specialized perinatal centers rather than isolated beds within hospitals of with low resolution rates. These centers should be interconnected and their practices constantly monitored and evaluated.
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