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Abstract Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30-11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32-0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26-15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38-7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25-10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.
RESUMO Objetivo: Este estudo foi realizado para compreender as disparidades na mortalidade e sobrevivência sem as principais morbidades entre recém-nascidos muito prematuros e de muito baixo peso entre Unidades de Terapia Intensiva Neonatal (UTINs) participantes da Rede Brasileira de Pesquisas Neonatais (RBPN) e Rede de Pesquisa Neonatal do Japão (NRNJ). Métodos: Foi realizada uma análise dos dados secundários dos bancos de dados da RBPN e da NRNJ. As pesquisas foram realizadas em 2014 e 2015 e incluíram 187 UTINs. O desfecho primário foi mortalidade ou sobrevida sem qualquer morbidade importante. Utilizou-se a análise de regressão logística com ajuste para os fatores de confusão. Resultados: A população do estudo foi composta por 6.406 recém-nascidos do NRNJ e 2.319 do RBPN. Ajustando para diversos fatores de confusão, os prematuros da RBPN tiveram 9,06 vezes maiores chances de mortalidade (IC95% 7,30-11,29) e menores chances de sobrevivência sem morbidades importantes (AOR 0,36; IC95% 0,32-0,41) em comparação com os da NRNJ. Fatores associados a maiores chances de mortalidade entre as UTINs brasileiras incluíram: síndrome de escape de ar (AOR 4,73; IC95% 1,26-15,27), enterocolite necrosante (AOR 3,25; IC95% 1,38-7,26) e sepse de início tardio (AOR 4,86; IC95% 2,25-10,97). Conclusões: Os recém-nascidos muito prematuros e de muito baixo peso do Brasil apresentaram chances significativamente maiores de mortalidade e menores chances de sobrevivência sem as principais morbidades em comparação aos do Japão. Além disso, identificamos os fatores que aumentam as chances da morte neonatal no Brasil, sendo a maioria relacionada à sepse tardia.
RESUMO
OBJECTIVE: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). METHODS: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. RESULTS: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30-11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32-0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26-15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38-7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25-10.97). CONCLUSIONS: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.
Assuntos
Doenças do Prematuro , Nascimento Prematuro , Sepse , Brasil/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Recém-Nascido de muito Baixo Peso , Japão/epidemiologia , MorbidadeRESUMO
OBJECTIVE: To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. STUDY DESIGN: We included 58â004 infants born weighing <1500 g at 24(0)-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. RESULTS: Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. CONCLUSIONS: We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
Assuntos
Doenças do Prematuro/mortalidade , Feminino , Saúde Global , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. METHODS: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. RESULTS: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. CONCLUSIONS: This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.
Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde do Lactente/tendências , Mortalidade Materna/tendências , Adulto , Cesárea/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/tendências , Países em Desenvolvimento , Feminino , Fertilidade , Saúde Global , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Trabalho de Parto Induzido/estatística & dados numéricos , Idade Materna , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Medicalização/tendências , Gravidez , Resultado da Gravidez , Prevenção Primária , Fatores Socioeconômicos , Natimorto/epidemiologia , Organização Mundial da Saúde , Adulto JovemRESUMO
OBJECTIVE: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. METHODS: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. RESULTS: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. CONCLUSIONS: This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.
RESUMEN OBJETIVO: Evaluar si las características propuestas del Modelo de Transición Obstétrica, un marco teórico que puede explicar los cambios graduales que experimentan los países a medida que eliminan la mortalidad materna evitable, se pueden observar en una amplia base de datos de salud materna y perinatal de varios países; y tratar sobre el proceso dinámico de reducción de la mortalidad materna utilizando este modelo como marco teórico. MÉTODOS: Este estudio consistió en un análisis secundario de un estudio transversal realizado por la Organización Mundial de la Salud que recopiló información sobre más de 300 000 mujeres que dieron a luz en 359 establecimientos de salud de 29 países de África, Asia, América Latina y Oriente Medio, durante un período de 2 a 4 meses en el 2010 y el 2011. Se calcularon los índices de afecciones potencialmente mortales, resultados maternos graves, morbilidad materna extremadamente grave, y muerte materna, y se estratificaron según las etapas de transición obstétrica. Se definen las características de cada etapa. RESULTADOS: Los datos de 314 623 mujeres indicaron que la fecundidad femenina, calculada indirectamente por el número de partos, fue mayor en los países que se hallaban en las primeras etapas de la transición obstétrica, desde un promedio de 3 hijos en el estadio II a 1,8 en el estadio IV. El nivel de medicalización de los establecimientos de salud de los países participantes, definido por el número de partos por cesárea y el número de partos inducidos, tuvo tendencia a aumentar según avanzaba la etapa de transición obstétrica. En el estadio IV, las mujeres tuvieron 2,4 veces más partos por cesárea (15,3% en el estadio II y 36,7% en el estadio IV) y 2,6 veces más inducciones de parto (7,1% en el estadio II y 18,8% en el estadio IV) que las mujeres en el estadio II. A medida que avanzaban las etapas de transición obstétrica, también se incrementaba la media de edad de las mujeres primíparas. La ocurrencia de rotura uterina mostraba una tendencia descendente, y se reducía 5,2 veces, de 178 a 34 casos por 100 000 nacidos vivos, a medida que un país efectuaba la transición del estadio II al IV. CONCLUSIONES: Este análisis apoya el concepto de transición obstétrica utilizando datos de varios países. El Modelo de Transición Obstétrica podría justificar la adaptación de las estrategias para reducir la mortalidad materna según la etapa de transición obstétrica en que se halla un país.
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Organização Mundial da Saúde , Mortalidade Materna , Fatores de Risco , Saúde MaternaRESUMO
OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroid (ACS) to improve neonatal outcomes for infants born at <24 weeks of gestation. STUDY DESIGN: We performed a retrospective analysis of 11,607 infants born at 22 to 33 weeks of gestation between 2003 and 2007 from the Neonatal Research Network of Japan. We evaluated the gestational age effects of ACS administered to mothers with threatened preterm birth on several factors related to neonatal morbidity and mortality. RESULTS: By logistic regression analysis, ACS exposure decreased respiratory distress syndrome and severe intraventricular hemorrhage in infants born between 24 and 29 weeks of gestation. Cox regression analysis revealed that ACS exposure was associated with a significant decrease in mortality of preterm infants born at 22 or 23 weeks of gestation (adjusted hazard ratio, 0.72; 95% CI, 0.53 to 0.97; P=.03). This effect was also observed at 24 to 25 and 26 to 27 weeks of gestation and in the overall study population. CONCLUSIONS: ACS exposure improved survival of extremely preterm infants. ACS treatment should be considered for threatened preterm birth at 22 to 23 weeks of gestation.
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Corticosteroides/uso terapêutico , Hemorragia Cerebral/mortalidade , Recém-Nascido Prematuro , Cuidado Pré-Natal , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Estudos de Casos e Controles , Hemorragia Cerebral/prevenção & controle , Uso de Medicamentos , Permeabilidade do Canal Arterial/mortalidade , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Mortalidade Hospitalar , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Japão/epidemiologia , Masculino , Análise Multivariada , Oxigenoterapia , Gravidez , Nascimento Prematuro/prevenção & controle , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Estudos RetrospectivosRESUMO
Introducción: Dado que en algunas investigaciones se demuestra que la puntuación de Apgar no es lo suficientemente precisa para estimar el pronóstico neonatal, en especial en los niños prematuros, se debate la posibilidad de discontinuar su utilización. Métodos: Este es un análisis poblacional transversal de los registros disponibles de todos los neonatos internados en 37 unidades neonatales en la Prefectura de Osaka, Japón. Mediante la estratificación en función del peso al nacer y de la edad gestacional, se calculó, para la puntuación de Apgar, el valor predictivo, la sensibilidad, la especificidad y los cocientes positivo y negativo de probabilidad para determinar la mortalidad neonatal para cada umbral de puntaje entre 0 y 9 puntos. Resultados: En los neonatos prematuros y de bajo peso al nacer, el área bajo la curva (ABC) se incrementó con el aumento de la edad gestacional y del peso al momento del nacimiento. La puntuación de Apgar a los 5 minutos siempre se asoció con mayores valores de ABC y de cociente positivo de probabilidad que la puntuación calculada en el primer minuto. El ABC de la puntuación de Apgar a los 5 minutos para los niños con un peso al nacer comprendido entre 1 500 y 2 499 g y para edades gestacionales de entre 32 y 36 semanas fue de 0.89 y 0.91, respectivamente. Conclusión: El valor predictivo de la puntuación de Apgar no fue similar a lo largo del tiempo y los grupos poblacionales. En Osaka, Japón, la puntuación de Apgar es una variable predictiva para los neonatos con un peso al nacer de entre 1 500 y 2499 g o con una edad gestacional de 32 a 36 semanas. Para estratificar la precisión del valor predictivo de la puntuación de Apgar, la edad gestacional es un parámetro más adecuado que el peso al nacer.(AU)
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Humanos , Gravidez , Recém-Nascido , Feminino , Índice de Apgar , Recém-Nascido de Baixo Peso , Diagnóstico Pré-Natal , Recém-Nascido Prematuro , Mortalidade InfantilRESUMO
Introducción: Dado que en algunas investigaciones se demuestra que la puntuación de Apgar no es lo suficientemente precisa para estimar el pronóstico neonatal, en especial en los niños prematuros, se debate la posibilidad de discontinuar su utilización. Métodos: Este es un análisis poblacional transversal de los registros disponibles de todos los neonatos internados en 37 unidades neonatales en la Prefectura de Osaka, Japón. Mediante la estratificación en función del peso al nacer y de la edad gestacional, se calculó, para la puntuación de Apgar, el valor predictivo, la sensibilidad, la especificidad y los cocientes positivo y negativo de probabilidad para determinar la mortalidad neonatal para cada umbral de puntaje entre 0 y 9 puntos. Resultados: En los neonatos prematuros y de bajo peso al nacer, el área bajo la curva (ABC) se incrementó con el aumento de la edad gestacional y del peso al momento del nacimiento. La puntuación de Apgar a los 5 minutos siempre se asoció con mayores valores de ABC y de cociente positivo de probabilidad que la puntuación calculada en el primer minuto. El ABC de la puntuación de Apgar a los 5 minutos para los niños con un peso al nacer comprendido entre 1 500 y 2 499 g y para edades gestacionales de entre 32 y 36 semanas fue de 0.89 y 0.91, respectivamente. Conclusión: El valor predictivo de la puntuación de Apgar no fue similar a lo largo del tiempo y los grupos poblacionales. En Osaka, Japón, la puntuación de Apgar es una variable predictiva para los neonatos con un peso al nacer de entre 1 500 y 2499 g o con una edad gestacional de 32 a 36 semanas. Para estratificar la precisión del valor predictivo de la puntuación de Apgar, la edad gestacional es un parámetro más adecuado que el peso al nacer.