Revista Brasileira de Terapia Intensiva (Dec 2012)
Características epidemiológicas e óbitos de prematuros atendidos em hospital de referência para gestante de alto risco Epidemiological characteristics and deaths of premature infants in a referral hospital for high-risk pregnancies
Abstract
OBJETIVO: Analisar o processo da assistência prestada aos prematuros atendidos em uma unidade de terapia intensiva neonatal e os fatores associados à sua mortalidade. MÉTODOS: Estudo transversal de dados retrospectivos de prematuros de uma unidade de terapia intensiva no triênio 2008-2010. Descreveram-se características maternas e dos prematuros e realizou-se análise bivariada entre estas, o período de estudo e o desfecho "óbito" (hospitalar, neonatal e precoce) pelos testes do qui-quadrado de Pearson, exato de Fisher ou qui-quadrado de tendência linear. Aplicou-se a regressão logística bivariada e multivariável pelo método Stepwise Backward LR entre as variáveis com pOBJECTIVE: To analyze the process of care provided to premature infants in a neonatal intensive care unit and the factors associated with their mortality. METHODS: Cross-sectional retrospective study of premature infants in an intensive care unit between 2008 and 2010. The characteristics of the mothers and premature infants were described, and a bivariate analysis was performed on the following characteristics: the study period and the "death" outcome (hospital, neonatal and early) using Pearson's chi-square test, Fisher's exact test or a chi-square test for linear trends. Bivariate and multivariable logistic regression analyses were performed using a stepwise backward logistic regression method between the variables with p<0.20 and the "death" outcome. A p value <0.05 was considered to be significant. RESULTS: In total, 293 preterm infants were studied. Increased access to complementary tests (transfontanellar ultrasound and Doppler echocardiogram) and breastfeeding rates were indicators of improving care. Mortality was concentrated in the neonatal period, especially in the early neonatal period, and was associated with extreme prematurity, small size for gestational age and an Apgar score <7 at 5 minutes after birth. The late-onset sepsis was also associated with a greater chance of neonatal death, and antenatal corticosteroids were protective against neonatal and early deaths. CONCLUSIONS: Although these results are comparable to previous findings regarding mortality among premature infants in Brazil, the study emphasizes the need to implement strategies that promote breastfeeding and reduce neonatal mortality and its early component.
