Revista Brasileira de Terapia Intensiva (Mar 2010)
Fatores de risco para óbito em unidade de terapia intensiva neonatal, utilizando a técnica de análise de sobrevida Risk factors for neonatal death in neonatal intensive care unit according to survival analysis
Abstract
OBJETIVO: Identificar fatores de risco associados ao óbito de recém-nascidos internados na unidade de terapia intensiva neonatal do Hospital Universitário de Taubaté, SP. MÉTODOS: É um estudo longitudinal com informações obtidas dos prontuários dos recém-nascidos internados na unidade de terapia intensiva neonatal, do Hospital Universitário da Universidade de Taubaté. A variável dependente foi o tipo de desfecho: alta ou óbito. As variáveis independentes foram variáveis maternas e gestacionais: idade materna, hipertensão, diabetes, terapia com corticóide e parto; variáveis do recém-nascido: peso ao nascer, duração da gestação, escore de Apgar no primeiro e quinto minutos de vida, nascimento múltiplo, malformações congênitas e sexo; variáveis relativas à internação: relato de ventilação mecânica, ventilação pressão positiva, relato de nutrição parenteral prolongada, sepse, entubação, massagem cardíaca, fototerapia, doença da membrana hialina, oxigênioterapia, tempo de internação e fração inspirada de oxigênio. Foi construído um modelo de forma hierarquizada em três níveis para análise de sobrevida, através do modelo de Cox; o programa computacional utilizado foi o Stata v9 e permaneceram no modelo final as variáveis com pOBJECTIVE: To identify risk factors associated with death of infants admitted to neonatal intensive care unit of Taubaté University Hospital. METHODS: It is a longitudinal study with information obtained from medical records of newborns admitted to the neonatal intensive care unit of Taubaté University Hospital. Type of outcome, discharge or death, was dependent variable. The independent variables were maternal and gestational variables: maternal age, hypertension, diabetes, corticosteroid therapy and delivery; variables of the newborn: birth weight, gestation length, Apgar score in the first and fifth minutes of life, multiple birth, congenital malformations and sex; hospitalar variables: report of mechanical ventilation, positive pressure ventilation, reports of prolonged parenteral nutrition, sepsis, intubation, cardiac massage, phototherapy, hyaline membrane disease, oxygen and fraction of inspired oxygen. It was built a model in three hierarchical levels for the survival analysis by the Cox model; it was used the software Stata v9 and the final model contained variables with p <0.05. The risks were estimated by measure effect known as hazard ratio (HR) with confidence intervals of 95%. The newborns transferred during hospitalization to another service were excluded from the study. RESULTS: There were admitted during the study period 495 newborns, with 129 deaths (26.1%). In the final model, only the variables of steroid use (HR 1.64, 95% CI 1.02-2.70), malformation (HR 1.93, CI 95% 1,05-2,88), very low birth weight (HR 4.28, 95% CI 2,79-6,57) and Apgar scores lower than seven of no1 min (HR 1.87, 95% CI 1,19-2,93) and 5 min (HR 1.74, 95% CI 1,05-2,88) and the variables phototherapy (HR 0.34; 95% CI 0,22-0,53) and endotracheal intubation (HR 2.28, 95% CI 1 .41-3, 70). CONCLUSION: Factors related primarily to the newborn and the hospitalar internment (except therapy with corticosteroids) were identified as associated to mortality highlighting a possible protective factor of phototherapy and the risk of infants with very low birth weight.
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