Silva Zilda Pereira da, Almeida Márcia Furquim de, Ortiz Luís Patrício, Alencar Gizelton Pereira, Alencar Airlane Pereira, Schoeps Daniela, Minuci Elaine Garcia, Novaes Hillegonda Maria Dutilh
Fundação Sistema Estadual de Análise de Dados, São Paulo, Brasil.
Cad Saude Publica. 2010 Jan;26(1):123-34. doi: 10.1590/s0102-311x2010000100013.
The aim of this study was to analyze the profile of newborns, mothers, and early neonatal mortality according to the hospital's complexity and affiliation (or lack thereof) with the Unified National Health System (SUS) in Greater Metropolitan São Paulo, Brazil. The study was based on data for live births, deaths, and hospital registries. Factor and cluster analysis were used to obtain the typology of hospital complexity and user profile. The SUS treats more high-risk newborns and mothers with low schooling, insufficient prenatal care, and teenage mothers. The probability of early neonatal death was 5.6 live births (65% higher in the SUS), with no significant differences by level of hospital complexity, except those with extremely high (SUS) and medium (non-SUS) complexity. The difference in early neonatal mortality between the two systems was smaller in the group of newborns with birth weight < 1,500g (22%), but the rate was 131% higher in the SUS for newborns > 2,500g. There was a concentration of high-risk births in the SUS, but the difference in early neonatal mortality between SUS and non-SUS hospitals was smaller in this group of newborns. New studies are needed to elucidate the high mortality rate among newborns with birth weight > 2,500g in the SUS.
本研究旨在根据巴西大圣保罗地区医院的复杂性以及与国家统一卫生系统（SUS）的隶属关系（或无隶属关系），分析新生儿、母亲的情况以及早期新生儿死亡率。该研究基于活产、死亡和医院登记数据。采用因子分析和聚类分析来确定医院复杂性类型和用户特征。SUS治疗的高危新生儿和母亲更多，这些母亲受教育程度低、产前护理不足且为青少年母亲。早期新生儿死亡概率为每5.6例活产中有1例（在SUS中高出65%），除了极高复杂性（SUS）和中等复杂性（非SUS）的医院外，不同医院复杂性水平之间无显著差异。在出生体重<1500g的新生儿组中，两个系统之间早期新生儿死亡率的差异较小（22%），但在出生体重>2500g的新生儿中，SUS中的死亡率高出131%。SUS中存在高危分娩集中的情况，但在这组新生儿中，SUS和非SUS医院之间早期新生儿死亡率的差异较小。需要开展新的研究来阐明SUS中出生体重>2500g的新生儿死亡率高的原因。
