RESUMO
[Extraído do Prólogo]. "O presente manual tem como antecedente o livro “Atendimento Pré-natal e Parto de Baixo Risco”, que foi publicado pelo CLAP em 1995, sendo atualizado em todos os assuntos e com o seu enfoque ampliado, aprofundando os conteúdos dos cuidados pré-gestacionais com um critério de promoção e de prevenção que procura melhorar o estado de saúde da mulher, do seu parceiro e do seu filho/a, com medidas relativamente simples. Incorpora também novos aspectos sobre planejamento familiar com um enfoque de direitos, onde é incluída a anticoncepção de emergência e o conceito de atendimento integral para evitar as oportunidades perdidas e melhorar a eficiência dos contatos do pessoal de saúde com a mulher e seu filho/a" .
Assuntos
Saúde Reprodutiva , Atenção Primária à Saúde , Doenças do Recém-Nascido , Assistência Perinatal , Hemorragia Pós-Parto , Transmissão Vertical de Doenças Infecciosas , Saúde Materno-Infantil , Cuidado Pós-Natal , Cuidado Pré-Natal , Período Pós-Parto , AbortoAssuntos
Humanos , Masculino , Feminino , Prontuários Médicos , Assistência Perinatal , PerinatologiaAssuntos
Humanos , Masculino , Feminino , Perinatologia , Assistência Perinatal , Prontuários MédicosRESUMO
BACKGROUND: Kangaroo mother care (KMC), defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. OBJECTIVES: To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional care after the initial period of stabilization with conventional care. SEARCH STRATEGY: We used the standard search strategy of the Neonatal Review Group of the Cochrane Collaboration. MEDLINE, EMBASE, LILACS, POPLINE and CINAHL databases (to December 2002), and the Cochrane Controlled Trials Register (The Cochrane Library), were searched using the key words terms "kangaroo mother care" or "kangaroo care" or "kangaroo mother method" or "skin-to-skin contact" and "infants" or "low birthweight infants". SELECTION CRITERIA: Randomized trials comparing KMC and conventional neonatal care in LBW infants. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Statistical analysis was conducted using the standard Cochrane Collaboration methods. MAIN RESULTS: Three studies, involving 1362 infants, were included. All the trials were conducted in developing countries. The studies were of moderate to poor methodological quality. The most common shortcomings were in the areas of blinding procedures for those who collected the outcomes measures, handling of drop outs, and completeness of follow-up. The great majority of results consist of results of a single trial. KMC was associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months follow-up (relative risk 0.37, 95% confidence interval 0.15 to 0.89), not exclusively breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68), and maternal dissatisfaction with method of care (relative risk 0.41, 95% confidence interval 0.22 to 0.75). KMC infants had gained more weight per day by discharge (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Scores on mother's sense of competence according to infant stay in hospital and admission to NICU were better in KMC than in control group (weighted mean differences 0.31 [95% confidence interval 0.13 to 0.50] and 0.28 [95% confidence interval 0.11 to 0.46], respectively). Scores on mother's perception of social support according to infant stay in NICU were worse in KMC group than in control group (weighted mean difference -0.18 (95% confidence interval -0.35 to -0.01). Psychomotor development at 12 months' corrected age was similar in the two groups. There was no evidence of a difference in infant mortality. However, serious concerns about the methodological quality of the included trials weaken credibility in these findings. REVIEWER'S CONCLUSIONS: Although KMC appears to reduce severe infant morbidity without any serious deleterious effect reported, there is still insufficient evidence to recommend its routine use in LBW infants. Well designed randomized controlled trials of this intervention are needed.
Assuntos
Cuidado do Lactente/métodos , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Estimulação Física/métodos , Humanos , Recém-Nascido , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto , Aumento de PesoRESUMO
OBJECTIVE: To compare morbidity and mortality in very low birthweight infants admitted to public and private intensive care units in Montevideo, Uruguay. METHODS: Longitudinal design. All very low birth weight infants born in public hospitals of Montevideo between May 1st and October 31st, 1999, were included in the study and followed up until they were discharged from hospital, or died. The quality of care, and morbidity and mortality rates obtained in private intensive care units were compared with those observed in public intensive care units (infants who were never transferred). RESULTS: Of 141 infants, 19 were excluded from the study (13 died at the delivery room and six were transferred to intensive care units of other public hospitals). Of the remaining 122 infants, 61 were kept at the intensive care units of public hospitals, and 61 were transferred to a private unit. The infants who were transferred presented lower gestational age and increased neonatal depression. However, mortality among infants treated at intensive care units of public hospitals was twice as high (Hazard Ratio 1.8; 95%CI 1.1-3.4; P=0.04), especially in infants who weighed less than 1,000g (Hazard Ratio 2.4; 95%CI 1.1-5.5; P=0.04). CONCLUSIONS: The health status of very low birth weight infants treated at intensive care units of public and private hospitals in Montevideo, Uruguay, was assessed. Mortality was lower, and health care was better in neonatal units of private hospitals.
RESUMO
The Perinatal Information System (SIP) is a clinical record, local management and quality assurance software standard in Latin America and the Caribbean. The time to implement SIP in a Maternity Hospital is evaluated as well as the effect of statistics on perinatal health indicators in subsequent years. In the sample of 20 Maternity Hospitals (5 Countries, 40% Private and 60% Public) 85% had a reliable information system by the third year of use of SIP. 15% of hospitals still had problems at that time that were already clear during the second year, a time corrective measures can still be taken. The evaluation of the impact of yearly reports shows that 58% of recommendations were fulfilled, specially those regarding the complete filling-in of clinical records (62%) and to a lesser extent variables that reflect clinical practices and organization of services (52%). The conclusion is that Maternity Hospitals in Latin America and the Caribbean have the capacity to adopt a complex tool of computerized clinical records for quality assurance of perinatal care and monitoring of health indicators.
Assuntos
Sistemas Computadorizados de Registros Médicos/organização & administração , Assistência Perinatal/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Feminino , Humanos , América Latina , GravidezRESUMO
BACKGROUND: Kangaroo mother care (KMC), defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. OBJECTIVES: To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional care after the initial period of stabilization with conventional care. SEARCH STRATEGY: We used the standard search strategy of the Neonatal Review Group of the Cochrane Collaboration. MEDLINE, EMBASE, LILACS, POPLINE and CINAHL databases, and the Cochrane Controlled Trials Register (Cochrane Library) up to Issue 2, 2000, were searched using the key words terms "kangaroo mother care" or "kangaroo mother method" or "skin-to-skin contact" and "infants" or "low birthweight infants". SELECTION CRITERIA: Randomised trials comparing KMC and conventional neonatal care in LBW infants. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Statistical analysis was conducted using the standard Cochrane Collaboration methods. MAIN RESULTS: Three studies, involving 1362 infants, were included. All the trials were conducted in developing countries. The studies were of moderate to poor methodological quality. The most common shortcomings were in the areas of blinding procedures for those who collected the outcomes measures, handling of drop outs, and completeness of follow-up. The great majority of results consist of results of a single trial. KMC was associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months follow-up (relative risk 0.37, 95% confidence interval 0.15 to 0.89), not exclusively breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68), and maternal dissatisfaction with method of care (relative risk 0.41, 95% confidence interval 0.22 to 0.75). KMC infants had gained more weight per day by discharge (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Scores on mother's sense of competence according to infant stay in hospital and admission to NICU were better in KMC than in control group (weighted mean differences 0.31 [95% confidence interval 0.13 to 0.50] and 0.28 [95% confidence interval 0.11 to 0.46], respectively). Scores on mother's perception of social support according to infant stay in NICU were worse in KMC group than in control group (weighted mean difference -0.18 (95% confidence interval -0.35 to -0.01). There was no evidence of a difference in infant mortality. However, serious concerns about the methodological quality of the included trials weaken credibility in these findings. REVIEWER'S CONCLUSIONS: Although KMC appears to reduce severe infant morbidity without any serious deleterious effect reported, there is still insufficient evidence to recommend its routine use in LBW infants. Well designed randomized controlled trials of this intervention are needed.
Assuntos
Educação Infantil , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Relações Pais-Filho , Aleitamento Materno , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Estimulação Física , Ensaios Clínicos Controlados Aleatórios como Assunto , Aumento de PesoRESUMO
BACKGROUND: To identify risk factors associated with fetal death, and to measure the rate and the risk of fetal death in a large cohort of Latin American women. METHODS: We analyzed 837,232 singleton births recorded in the Perinatal Information System Database of the Latin American Center for Perinatology and Human Development (CLAP) between 1985 and 1997. The risk factors analyzed included fetal factors and maternal sociodemographic, obstetric, and clinical characteristics. Adjusted relative risks were obtained, after adjustment for potential confounding factors, through multiple logistic regression models based on the method of generalized estimating equations. RESULTS: There were 14,713 fetal deaths (rate=17.6 per 1000 births). The fetal death risk increased exponentially as pregnancy advanced. Thirty-seven percent of all fetal deaths occurred at term, and 64% were antepartum. The main risk factors associated with fetal death were lack of antenatal care (adjusted relative risk [aRR]=4.26; 95% confidence interval, 3.84-4.71) and small for gestational age (aRR=3.26; 95% CI, 3.13-3.40). In addition, the risk of death during the intrapartum period was almost tenfold higher for fetuses in noncephalic presentations. Other risk factors associated with stillbirth were: third trimester bleeding, eclampsia, chronic hypertension, preeclampsia, syphilis, gestational diabetes mellitus, Rh isoimmunization, interpregnancy interval<6 months, parity > or =4, maternal age > or =35 years, illiteracy, premature rupture of membranes, body mass index > or =29.0, maternal anemia, previous abortion, and previous adverse perinatal outcomes. CONCLUSIONS: There are several preventable factors that should be dealt with in order to reduce the gap in fetal mortality between Latin America and developed countries.
Assuntos
Morte Fetal/epidemiologia , Resultado da Gravidez , Adolescente , Adulto , Anemia/complicações , Criança , Estudos de Coortes , Diabetes Gestacional/complicações , Eclampsia/complicações , Escolaridade , Feminino , Morte Fetal/etiologia , Ruptura Prematura de Membranas Fetais/complicações , Humanos , Hipertensão/complicações , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , América Latina/epidemiologia , Masculino , Estado Civil , Idade Materna , Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal , Sistema do Grupo Sanguíneo Rh-Hr , Fatores de Risco , Fumar/efeitos adversos , Sífilis/complicaçõesAssuntos
Medicina Baseada em Evidências , Pediatria , Criança , Previsões , Humanos , Expectativa de Vida , Morbidade , Pediatria/tendênciasRESUMO
The progress in information and communication technology, together with the search for the most effective and efficient ways to use the limited resources for health care, are opening new areas for research and development in perinatal care. Information systems and practice oriented by evidence-based medicine are modifying the operation of health services, and the quality of their management is being monitored by the success of their outcomes. As a study case, a Perinatal Information System widely used in Latin America and the Caribbean is discussed in some detail. Future challenges in the compatibility of information systems and databanks, the need for longer follow-up periods and measurement of health-related quality of life as outcomes for perinatal care, and the strategies to integrate all these concepts for the improvement of daily practice are discussed.
PIP: The success in information and communication technology, together with the search for the most effective and efficient ways to use the limited resources for health care, are opening new areas for research and development in perinatal care. The quality of the population-based databanks and individual patient care may benefit from improvements in the design of the clinical records. Information systems and practice oriented by evidence-based medicine are modifying the operation of health services, and the quality of their management is being monitored by the success of their outcomes. This paper discusses in detail the experiences of the two countries--Latin America and the Caribbean--in using the Perinatal Information System. Furthermore, this paper discusses the future challenges in the compatibility of information systems and databanks, the need for longer follow-up periods and measurement of health-related quality of life as outcomes for perinatal care, and the strategies to integrate all these concepts for the improvement of daily practice.