Marinonio Ana Sílvia Scavacini, Miyoshi Milton Harumi, Nobre Daniela Testoni Costa, Sanudo Adriana, Areco Kelsy Catherina Nema, Kawakami Mandira Daripa, Balda Rita de Cássia Xavier, Konstantyner Tulio, Oliveira Carina Nunes Vieira E, Bandiera-Paiva Paulo, Freitas Rosa Maria Vieira de, Teixeira Monica La Porte, Waldvogel Bernadette Cunha, Kiffer Carlos Roberto Veiga, Almeida Maria Fernanda Branco de, Guinsburg Ruth
Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.
Fundação Sistema Estadual de Análise de Dados, São Paulo, SP, Brazil.
Rev Paul Pediatr. 2025 Jan 20;43:e2024138. doi: 10.1590/1984-0462/2025/43/2024138. eCollection 2025.
The aim of this study was to analyze if the healthcare organization of perinatal care and availability of referral neonatal intensive care units (NICU) impacted congenital diaphragmatic hernia (CDH) neonatal mortality in the period 2004-2020. This study analyzed the spatial distribution of neonatal deaths of live births with CDH in São Paulo State, Brazil, and its association with NICU beds' availability.
Population-based study of all live births in São Paulo State from mothers residing in the same State, from 2004 to 2020. CDH definition was based on WHO-ICD-10 codes; CDH-associated neonatal death was defined as death up to 27 days after birth of infants with CDH. The distribution of CDH-associated neonatal mortality (per 10,000 live births) and NICU beds' availability (≥1 or not available) was mapped, and their association was evaluated by the Mann-Whitney test.
Among 10,246,686 live births, there were 1378 CDH-associated neonatal deaths across 124/645 (19.2%) municipalities of the State. The median CDH-associated neonatal mortality rate in municipalities with NICU beds was 1.22 (95%CI 0.99-1.51), similar to that found in municipalities with no NICU beds (1.40; 95%CI 1.15-1.67; p=0.224).
CDH-associated neonatal deaths were spread throughout São Paulo State with no difference in CDH-associated neonatal mortality rates between municipalities with and without NICU beds available. These findings suggest the necessity of implementing regionalization strategies for CDH perinatal care in the State.
本研究旨在分析围产期护理的医疗保健组织以及转诊新生儿重症监护病房（NICU）的可用性是否会影响2004年至2020年期间先天性膈疝（CDH）新生儿的死亡率。本研究分析了巴西圣保罗州患有CDH的活产新生儿死亡的空间分布及其与NICU床位可用性的关联。
基于人群的研究，对象为2004年至2020年居住在圣保罗州且母亲也居住在该州的所有活产儿。CDH的定义基于世界卫生组织国际疾病分类第10版（WHO-ICD-10）编码；与CDH相关的新生儿死亡定义为患有CDH的婴儿出生后27天内的死亡。绘制了与CDH相关的新生儿死亡率（每10000例活产儿）和NICU床位可用性（≥1张或无）的分布图，并通过曼-惠特尼检验评估它们之间的关联。
在10246686例活产儿中，该州124/645（19.2%）个市共有1378例与CDH相关的新生儿死亡。有NICU床位的市中，与CDH相关的新生儿死亡率中位数为1.22（95%置信区间0.99-1.51），与没有NICU床位的市（1.40；95%置信区间1.15-1.67；p=0.224）相似。
与CDH相关的新生儿死亡分布在圣保罗州各地，有NICU床位和没有NICU床位的市之间，与CDH相关的新生儿死亡率没有差异。这些发现表明该州有必要实施CDH围产期护理的区域化策略。
