Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil.
J Pediatr (Rio J). 2011;87(3):257-62. doi: 10.2223/JPED.2094. Epub 2011 May 9.
To evaluate the effect of place of birth and transport on morbidity and mortality of preterm newborns in the southern region of Brazil.
This cohort study included preterm newborns transported to a reference intensive care unit (transport group = 61) and followed up until discharge. Data about care in hospital of origin and transport were obtained at admission. This group was compared with infants born in the maternity ward of the reference hospital paired according to gestational age (control group = 123). Primary outcome was death, and secondary outcomes were changes in blood glucose, temperature and oxygen saturation at admission and the incidence of necrotizing enterocolitis, bronchopulmonary dysplasia and sepsis. Relative risk (RR) was used to evaluate the association between variables and outcome. The level of significance was set at α = 5% and β = 90%.
Mean travel distance was 91 km. Mean gestational age was 34 weeks. Of the neonates in the transport group, 23% (n = 14) did not receive pediatric care in the delivery room. During transportation, 33% of newborns were accompanied by a pediatrician, and the equipment available was: incubator (57%), infusion pump (13%), oximeter (49%) and device for blood glucose test (21%). The transport group had a greater incidence of hyperglycemia (RR = 3.2; 2.3-4.4), hypoglycemia (RR = 2.4; 1.4-4.0), hyperthermia (RR = 2.5; 1.6-3.9), and hypoxemia (RR = 2.2; 1.6-3.0). The percentage of deaths was 18% in the transport group and 8.9% in the control group (RR = 2.0; 1.0-2.6).
This study revealed deficiencies in neonatal care and transport. Perinatal care and transport should be better organized in the northeastern region of Rio Grande do Sul, Brazil.
评估出生地和转运对巴西南部早产儿发病率和死亡率的影响。
本队列研究纳入了转运至参考重症监护病房的早产儿（转运组=61 例），并随访至出院。在入院时获得了关于原籍医院和转运期间的护理数据。将该组与根据胎龄配对的参考医院产科病房出生的婴儿（对照组=123 例）进行比较。主要结局为死亡，次要结局为入院时血糖、体温和血氧饱和度的变化，以及坏死性小肠结肠炎、支气管肺发育不良和败血症的发生率。相对风险（RR）用于评估变量与结局之间的关系。显著性水平设定为α=5%，β=90%。
平均转运距离为 91 公里。平均胎龄为 34 周。转运组中，23%（n=14）新生儿在产房未接受儿科护理。转运过程中，33%的新生儿有儿科医生陪同，可提供的设备包括：保温箱（57%）、输液泵（13%）、血氧计（49%）和血糖仪（21%）。转运组高血糖（RR=3.2；2.3-4.4）、低血糖（RR=2.4；1.4-4.0）、体温过高（RR=2.5；1.6-3.9）和低氧血症（RR=2.2；1.6-3.0）的发生率更高。转运组的死亡率为 18%，对照组为 8.9%（RR=2.0；1.0-2.6）。
本研究揭示了新生儿护理和转运方面的不足。巴西南里奥格兰德州东北部地区应更好地组织围产期护理和转运。
