Rev Chil Pediatr 2010; 81 (5): 465-466

CONO SUR

SOUTH CONE OF AMERICA

Esta sección contiene los artículos originales de las Revistas de Pediatría de las Sociedades de Pediatría del Cono Sur seleccionados en el XIV encuentro de Editores, Brasilia, Brasil 2009, para ser publicados por los países integrantes du-rante el año 2010.                                                                                                                                             

Factores Perinatales Asociados a Muerte Temprana de Niños Nacidos Prematuros en la Red Brasilera de Centros de Investigación Neonatal

Perinatal Factors Associated with Early Deaths of Preterm Infants Born in Brazilian Network on Neonatal Research Centers

MARIA FERNANDA BRANCO DE ALMEIDA¹, RUTH GUINSBURG², FRANCISCO EULÓGIO MARTINEZ³, RENATO S. PROCIANOY⁴, CLÉA RODRIGUES LEONE⁵, SÉRGIO TADEU MARTINS MARBA⁶, LÍGIA MARIA SOUSA SUPPO RUGOLO⁷, JORGE HECKER LUZ⁸, JOSÉ MARIA DE ANDRADE LOPES⁹

1.   Professora assodada, Disciplina de Pediatra Neonatal, Universidade Federal de Sao Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Sao Paulo, SP, Brazil.

2.   Professora titular, Disciplina de Pediatra Neonatal, UNIFESP-EPM, Sao Paulo, SP, Brazil.

3.   Professor titular, Departamento de Pediatría, Faculdade de Medicina de Ribeiráo Preto, Universidade de Sao Paulo (USP), Ribeiráo Preto, SP, Brazil.

4.   Professor titular, Departamento de Pediatría, Faculdade de Medicina, Universidade de Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.

5.   Professora assodada, livre-docente, Departamento de Pediatría, Faculdade de Medicina, USP, Sao Paulo, SP, Brazil.

6.   Professor livre-docente, Departamento de Pediatría, Faculdade de Ciencias Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.

7.   Professora adjunta, livre-docente, Departamento de Pediatría, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.

8.   Mestre, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.

9.   Doutor. Chefe, Clínica de Neonatologia, Instituto Fernandes Figueira, Fundagáo Osvaldo Cruz (FIOCRUZ), Rio de Janeiro, FU, Brazil.

ABSTRACT

Obj ective: To evaluate perinatal factors as sociated with early neonatal death in preterm infants with birth weights (BW) of 400 -1,500 g. Methods: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. Results: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6) and network center of birth. Conclusion: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.

(Key words: Neonatal mortality, infant, newborn, infant, preterm, infant, very low birth weight).

(Palabras clave: Mortalidad neonatal, recién nacido, lactante, pretermino, muy bajo peso de nacimiento). J Pediatr (Rio J). 2008; 84 (4): 300-307.

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Correspondencia a:
Ruth Guinsburg
E-mail: ruthgbr@netpoint.com.br