RESUMO
AIM: To analyze the association between neonatal near miss and infant development at two years. METHODS: Data from two birth cohorts, one conducted in Ribeirão Preto (RP)/São Paulo and the other in São Luís (SL)/Maranhão, were used. The cognitive, motor and communication development of children was evaluated using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). The following criteria were used for the definition of NNM: birth weight < 1,500 g, 5-min Apgar score < 7, gestational age < 32 weeks, and report of congenital malformations. The relationship between neonatal near miss and development was assessed using the weighted propensity score from the Inverse Probability of Treatment Weighting (IPTW). A directed acyclic graph was built to select the adjustment variables. RESULTS: A total of 1,050 mother-newborn dyads were evaluated in SL and 1,840 in RP. Regarding outcomes in SL and RP, respectively, 2.4% and 17.3% of the children were not competent in the cognitive domain, 12.1% and 13.3% in the receptive communication domain, 39.2% and 47.1% in the expressive communication domain, 20.7% and 12.6% in the fine motor domain, and 14.3% and 13.8% in the gross motor domain. The prevalence of neonatal near miss was 5.4% in SL and 4.3% in RP. Unadjusted analysis showed an association of neonatal near miss with fine motor development in SL and RP and with the cognitive, receptive communication, expressive communication, and gross motor domains only in RP. These associations remained after adjusted analysis. CONCLUSION: Neonatal near miss is a risk factor for developmental delays.
Assuntos
Coorte de Nascimento , Near Miss , Recém-Nascido , Feminino , Humanos , Lactente , Fatores Socioeconômicos , Estudos de Coortes , Brasil/epidemiologia , Recém-Nascido de muito Baixo PesoRESUMO
BACKGROUND: To investigate the associations of maternal variables - sociodemographic, obstetrical and maternal near miss (MNM) variables - with neonatal near miss (NNM) using the new concept of NNM formulated by the Centro Latino-Americano de Perinatologia (CLAP) and the corresponding health indicators for NNM. METHODS: An analytical prospective cohort study was performed at maternity hospital for high-risk pregnancy in Northeastern Brazil. Puerperal women whose newborn infants met the selection criteria were subjected to interviews involving pretested questionnaires. Statistical analysis was performed with the Epi Info 3.5.1 program using the Chi square test and Fisher's exact test when appropriate, with a level of significance of 5%. A bivariate analysis was performed to evaluate differences between the groups. All the variables evaluated in the bivariate analysis were subsequently included in the multivariate analysis. For stepwise logistic regression analysis, a hierarchical model was plotted to assess variable responses and adverse outcomes associated with MNM and NNM variables. RESULTS: There were 1002 live births (LB) from June 2015 through May 2016, corresponding to 723 newborn infants (72.2%) without any neonatal adverse outcomes, 221 (22%) NNM cases, 44 (4.4%) early neonatal deaths and 14 (1.4%) late neonatal deaths. The incidence of NNM was 220/1000 LB. Following multivariate analysis, the factors that remained significantly associated with increased risk of NNM were fewer than 6 prenatal care visits (odds ratio (OR): 3.57; 95% confidence interval (CI): 2.57-4.94) and fetal malformations (OR: 8.78; 95% CI: 3.69-20.90). Maternal age older than 35 years (OR: 0.43; 95% CI: 0.23-0.83) and previous cesarean section (OR: 0.45; 95% CI: 0.29-0.68) protected against NNM. CONCLUSION: Based on the large differences between the NNM and neonatal mortality rates found in the present study and the fact that NNM seems to be a preventable precursor of neonatal death, we suggest that all cases of NNM should be audited. Inadequate prenatal care and fetal malformations increased the risk of NNM, while older maternal age and a history of a previous cesarean section were protective factors.
Assuntos
Maternidades/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Mortalidade Perinatal , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Idade Materna , Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Fatores de Proteção , Indicadores de Qualidade em Assistência à Saúde , Fatores de Risco , Adulto JovemRESUMO
In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization.
Assuntos
Humanos , Lactente , Recém-Nascido , Monitoramento Epidemiológico , Mortalidade Infantil , Assistência Perinatal/normas , Brasil/epidemiologia , América Latina/epidemiologia , Saúde Materna , MorbidadeRESUMO
OBJECTIVE: To develop and test markers of neonatal severe morbidity for the identification of neonatal near-miss cases. DESIGN: This is a database analysis of two World Health Organization cross-sectional studies: the Global Survey on Maternal and Perinatal Health (WHOGS) and the Multicountry Survey on Maternal and Newborn Health (WHOMCS). SETTING: The WHOGS was performed in 373 health facilities in 24 countries (2004-2008). The WHOMCS was conducted in 359 health facilities in 29 countries (2010-2011). POPULATION: Data were collected from hospital records of all women admitted for delivery and their respective neonates. METHODS: Pragmatic markers (birthweight <1750 g, Apgar score at 5 minutes <7, and gestational age <33 weeks) were developed with WHOGS data and validated with WHOMCS data. The diagnostic accuracy of neonatal characteristics and management markers of severity was determined in the WHOMCS. RESULTS: This analysis included 290 610 liveborn neonates from WHOGS and 310 436 liveborn neonates from WHOMCS. The diagnostic accuracy of pragmatic and management markers of severity for identifying early neonatal deaths was very high: sensitivity, 92.8% (95% CI 91.8-93.7%); specificity, 92.7% (95% CI 92.6-92.8%); positive likelihood ratio, 12.7 (95% CI 12.5-12.9); negative likelihood ratio, 0.08 (95% CI 0.07-0.09); diagnostic odds ratio, 163.4 (95% CI 141.6-188.4). A positive association was found between the frequency of neonatal near-miss cases and Human Development Index. CONCLUSION: Newborn infants presenting selected markers of severity and surviving the first neonatal week could be considered as neonatal near-miss cases. This definition and criteria may be seen as a basis for future applications of the near-miss concept in neonatal health. These tools can be used to inform policy makers on how best to apply scarce resources for improving the quality of care and reducing neonatal mortality.
Assuntos
Mortalidade Infantil , Nascido Vivo/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Adolescente , Adulto , África/epidemiologia , Índice de Apgar , Ásia/epidemiologia , Biomarcadores , Estudos Transversais , Feminino , Idade Gestacional , Pesquisas sobre Atenção à Saúde , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , América Latina/epidemiologia , Oriente Médio/epidemiologia , Valor Preditivo dos Testes , Gravidez , Reprodutibilidade dos Testes , Organização Mundial da Saúde , Adulto JovemRESUMO
Objetivos: Explorar o uso do conceito de near miss neonatal como uma ferramenta para a avaliação da qualidade do atendimento neonatal, já que 3 milhões de óbitos neonatais precoces ocorrem a cada ano em todo o mundo. A maioria desses óbitos é evitável e ocorre em países em desenvolvimento. Métodos: Esta é uma análise secundária do 2005 WHO Global Survey on Maternal and Perinatal Health, um estudo transversal. Nossa análise incluiu dados de 19 hospitais brasileiros selecionados aleatoriamente. Uma definição pragmática de near miss neonatal foi desenvolvida e testada. Os indicadores de near miss foram calculados. Resultados: Entre os 15.169 nascidos vivos incluídos nesta análise, 424 apresentaram pelo menos uma das seguintes condições: muito baixo peso ao nascer, menos de 30 semanas de gestação ao nascer ou escore de Apgar aos 5 minutos de vida menor que 7. De acordo com a definição operacional, esses sobreviventes de condições com risco de vida foram considerados casos de near miss. A taxa de mortalidade neonatal precoce foi de 8,2/1.000 nascidos vivos, e a taxa de near miss neonatal foi de 21,4 casos/1.000 nascidos vivos. Variações substanciais na mortalidade entre recém-nascidos com condições com risco de vida ao nascer foram observadas, o que sugere a existência de questões relacionadas à qualidade do atendimento intra-hospitalar. Conclusão: O conceito de near miss e os indicadores forneceram informações que poderiam ser úteis para avaliar a qualidade do atendimento e para estabelecer prioridades para outras avaliações e para a melhoria da atenção à saúde dos recém-nascidos.
Objectives: To explore the use of the neonatal near miss concept as a tool to evaluate the quality of neonatal care, as 3 million early neonatal deaths occur every year around the world and the majority of these deaths are avoidable and take place in developing countries. Methods: This is a secondary analysis of the 2005 WHO Global Survey on Maternal and Perinatal Health, a cross-sectional study, using data from 19 randomly selected Brazilian hospitals. A pragmatic definition of neonatal near miss was developed and tested. Near miss indicators were calculated. Results: Among the 15,169 live born infants included in this analysis, 424 presented at least one of the following conditions: very low birth weight, less than 30 gestational weeks at birth or an Apgar score at the 5th minute of life less than 7. According to the operational definition, these survivors from life-threatening conditions were considered neonatal near miss cases. The early neonatal mortality rate was 8.2/1,000 live births, the neonatal near miss rate was 21.4 neonatal near miss cases/1,000 live births. Substantial variations in the mortality among neonates with life-threatening conditions at birth were observed suggesting intra-hospital quality of care issues. Conclusion:The near miss concept and indicators provided information that could be useful to evaluate the quality of care and set priorities for further assessments and health care improvement for newborn infants.