Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, Brasil.
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2020 Jun 12;54:63. doi: 10.11606/s1518-8787.2020054001757. eCollection 2020.
To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014).
A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them.
Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3-1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001).
This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.
分析在 10 年间（2005 年至 2014 年）巴西里约热内卢州一系列先天性腹裂患儿的死亡率及其相关因素。
这是一项回顾性队列研究，通过概率链接将活产儿信息系统和死亡率信息系统的数据库相关联。最终数据库通过两个阶段构建：准备两个初始数据库和建立它们之间的关系。
早产儿和低出生体重儿的死亡风险较高，差异有统计学意义（p = 0.03 和 p = 0.006）。至于分娩地点，虽然产科病房的死亡率高于综合医院（p = 0.04；OR = 0.5；95%CI 0.3-1.0），但综合医院的分娩量较高（61.2%）。此外，对该单位与其他单位之间的死亡风险进行比较分析，发现综合医院的死亡风险高出 7.5 倍，产科病房的死亡风险高出 3.2 倍，差异均有统计学意义（p < 0.001）。此外，与三级医院相比，二级重症监护病房的新生儿死亡风险高 3.9 倍（p < 0.001）。
本研究促进了对新生儿先天性腹裂治疗的两种可能策略的讨论。首先，将治疗集中在三级医院，以便更详细和标准化地分析畸形情况。其次，或许更可行的是制定临床指南，规范在三级中心之外出生的婴儿的先天性腹裂即刻治疗，并规范他们的转运，直到到达三级中心。
