Castro Eveline Campos Monteiro de, Leite Álvaro Jorge Madeiro, Almeida Maria Fernanda Branco de, Guinsburg Ruth
Neonatal Unit of Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, 3678 aptº 1600 - Meireles, CEP: 60165-121, Fortaleza, CE, Brazil.
Department of Maternal and Child Health, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
BMC Pediatr. 2014 Dec 20;14:312. doi: 10.1186/s12887-014-0312-5.
In Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period. Therefore, this study aims at assessing perinatal factors associated with early neonatal deaths in very low birth weight preterm infants born in a region of Brazil with low Human Development Index.
Prospective cohort study of inborns with gestational age 23(0/7)-31(6/7) weeks and birthweight 500-1499 g without malformations in 19 public reference hospitals of the state capitals of Brazil's Northeast Region. Perinatal variables associated with early neonatal death were determined by Cox regression analysis.
Among 627 neonates, 179 (29%) died with 0-6 days after birth. Early death was associated to: absence of antenatal steroids (HR 1.59; 95% CI 1.11-2.27), multiple gestation (1.95; 1.28-3.00), male sex (2.01; 1.40-2.86), 5th minute Apgar <7 (2.93; 2.03-4.21), birthweight <1000 g (2.58; 1.70-3.88), gestational age <28 weeks (2.07; 1.42-3.02), use of surfactant (1.65; 1.04-2.59), and non-use of a pain scale (1.89; 1.24-2.89).
Biological variables and factors related to the quality of perinatal care were associated with the high chance of early death of preterm infants born in reference hospitals of Northeast Brazil.
在巴西，近年来早产率有所上升，且早产是新生儿期死亡的主要原因。因此，本研究旨在评估巴西人类发展指数较低地区出生的极低出生体重早产儿早期新生儿死亡的围产期相关因素。
对巴西东北部地区19家公立参考医院中胎龄为23(0/7)-31(6/7)周、出生体重500-1499克且无畸形的活产儿进行前瞻性队列研究。通过Cox回归分析确定与早期新生儿死亡相关的围产期变量。
在627例新生儿中，179例（29%）在出生后0-6天死亡。早期死亡与以下因素相关：未使用产前类固醇（风险比1.59；95%置信区间1.11-2.27）、多胎妊娠（1.95；1.28-3.00）、男性（2.01；1.40-2.86）、出生后5分钟阿氏评分<7分（2.93；2.03-4.21）、出生体重<1000克（2.58；1.70-3.88）、胎龄<28周（2.07；1.42-3.02）、使用表面活性剂（1.65；1.04-2.59）以及未使用疼痛量表（1.89；1.24-2.89）。
生物变量以及与围产期护理质量相关的因素与巴西东北部参考医院出生的早产儿早期死亡的高风险相关。
