de Carvalho Manoel, Gomes Maria Auxiliadora S M
Universidade Federal Fluminense, Rio de Janeiro, RJ.
J Pediatr (Rio J). 2005 Mar;81(1 Suppl):S111-8. doi: 10.2223/1310.
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).
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).
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.
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.
本文旨在回顾和讨论巴西围产期卫生系统中有关极低出生体重早产儿（<1500克）护理的流行病学指标和组织结构的医学文献。
对1990年至2004年的MEDLINE、Lilacs和SciELO数据库进行电子检索，并挑选出最相关的文章。卫生部的文件和报告（死亡率信息系统-SIM和活产信息系统-SINASC）。
自1990年以来观察到的婴儿死亡率下降和孕产妇高死亡率促使巴西政府将其战略重点放在为孕妇及其新生儿提供护理的组织和服务上。然而，对针对早产儿护理的行动进行批判性分析后发现，这些服务的覆盖范围和利用率并不统一，而且出生和死亡率记录也不可靠。新生儿床位的可用性非常有限，无法满足需求，特别是对于那些需要高度复杂护理的婴儿。必须克服一些重要挑战，以妥善应对引入不适当技术、合格卫生专业人员数量有限以及利用循证最佳实践来改善围产期护理的问题。
降低早产儿的发病率和死亡率需要在产前护理系统中进行更有效的规划和干预。为满足需求，应通过专门的围产期中心增加新生儿重症监护床位，而不是在分辨率较低的医院内设置孤立的床位。这些中心应相互连接，其做法应不断受到监测和评估。
