Centro Universitário UNINOVAFAPI. Curso de Nutrição. Teresina, PI, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2020 Dec 4;54:123. doi: 10.11606/s1518-8787.2020054002382. eCollection 2020.
This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil.
This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels.
At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss.
The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.
本研究评估了社会人口因素、产妇特征、卫生服务组织与巴西公立和私立妇产医院新生儿近死产之间的关联。
这是一项来自巴西出生研究（Nascer no Brasil）的前瞻性队列研究，于 2011 年至 2012 年进行。变量是根据文献确定的，并分为三个层次进行组织：远端、中间和近端。评估基于双变量分析及其各自的 p 值进行，具有显著性水平 <0.20 的变量使用 Wald 检验。对于多变量分析，将远端水平包含的变量插入模型中，当显著时（p<0.05）保留在模型中。在调整中间和近端水平时也是如此。
在远端水平，没有变量与结果显著相关。在中间水平，母亲年龄≥35 岁（相对风险 - RR = 1.32；95%CI 1.04-1.66）、剖宫产（RR = 1.34；95%CI 1.07-1.67）、吸烟（RR = 1.48；95%CI 1.04-2.10）、妊娠高血压综合征（RR = 2.29；95%CI 1.98-3.14）、孕前糖尿病（RR = 2.63；95%CI 1.36-5.05）和双胞胎妊娠（RR = 2.98；95%CI 1.90-4.68）是与结果相关的变量。在近端水平，产前保健不足（RR = 1.71；95%CI 1.36-2.16）和医院/妇产科位于首府（RR = 1.89；95%CI 1.40-2.55）与新生儿近死产相关。
结果表明，新生儿近死产受与卫生服务组织和产妇特征相关的变量影响。
