Kale Pauline Lorena, Mello-Jorge Maria Helena Prado de, Silva Kátia Silveira da, Fonseca Sandra Costa
Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.
Cad Saude Publica. 2017 May 18;33(4):e00179115. doi: 10.1590/0102-311X00179115.
We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births) and lack of prenatal care (80.8‰ live births). Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2), hemorrhage (OR = 2.2; 95%CI: 1.3-3.9), hypertension (OR = 3.0; 95%CI: 2.0-4.4), syphilis (OR = 3.3; 95%CI: 1.5-7.2), lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7), cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3), lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8) and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.
我们旨在评估2011年巴西圣保罗州和里约热内卢州六家公立妇产医院与新生儿危殆病例和新生儿死亡相关的因素。一项基于医院的前瞻性出生队列研究调查了有生命危险状况的活产儿中的这些结局。使用具有分层水平的多项逻辑回归模型检验关联。观察到梅毒感染产妇（每1000例活产中有52.2例）和缺乏产前护理（每1000例活产中有80.8例）的新生儿危殆发生率较高。产妇黑色皮肤（比值比=1.9；95%置信区间：1.2 - 3.2）、出血（比值比=2.2；95%置信区间：1.3 - 3.9）、高血压（比值比=3.0；95%置信区间：2.0 - 4.4）、梅毒（比值比=3.3；95%置信区间：1.5 - 7.2）、缺乏产前护理（比值比=5.6；95%置信区间：2.6 - 11.7）、剖宫产和医院与新生儿危殆相关；而出血（比值比=4.6；95%置信区间：1.8 - 11.3）、缺乏产前护理（比值比=17.4；95%置信区间：6.5 - 46.8）和医院与死亡相关。有必要改善孕妇和新生儿获得优质护理的机会，以减少新生儿生命危险状况。
