RESUMO
INTRODUCTION: Studies have shown that pneumococcal disease significantly increases morbidity and mortality rates in children 5 years old and under. These infections constitute the main cause of preventable deaths in the world, considering the availability of vaccination. Considering that Ecuador is in a high incidence region, despite the introduction of the vaccine, this study aims to describe the burden of hospitalized pneumococcal disease and related mortality in our country between 2005 and 2015, to help decision-making processes for the health authorities. METHODS: This cross-sectional study analyzes morbidity, mortality, and the situation in Ecuador caused by pneumococcal disease in children 5 years old and under between 2005 and 2015 using national databases. RESULTS: A total of 163,852 cases of children 5 years old and under were reported to have been hospitalized due to pneumococcal-related diseases. Males comprised 54.7% of the cases and females 45.3%. In 36% of the cases, the patients were 1 year old or under. The mortality rate due to pneumococcal disease in Ecuador in children aged 5 and under decreased in 48% during 2005-2015. CONCLUSION: The decrease in mortality can be related to the introduction of the vaccine and an increase in access to health care by the general population in the country. It is important to study the specific impact of the vaccine in the reduction of morbidity and mortality of children in Ecuador.
RESUMO
Background: Sepsis is one of the main causes of morbidity and mortality in neonates. Objective: To identify the risk factors for neonatal sepsis in a neonatal unit from March to October, 2016. Methods: Case-control study. The factors analyzed were: a) neonatal factors such as: type of delivery, sex, birth weight, gestational age, criteria for systemic inflammatory response syndrome, type of sepsis (early or late) and blood culture result; B) invasive methods such as: central catheterization, total parenteral nutrition, umbilical catheterization and mechanical ventilation; C) maternal factors such as: number of prenatal controls, infection during pregnancy, premature rupture of membranes, maternal age and maternal fever. Odds Ratio was used to determine association. Results: For the development of early-onset sepsis, significant risk factors were: thermodynamic imbalance, tachycardia and maternal fever. With regard to late-onset sepsis, significant associations were found for thermodynamic imbalance, umbilical catheterization, mechanical ventilation and insufficient prenatal care. Conclusions: Thermodynamic imbalance, tachycardia, mechanical ventilation, umbilical catheterization, maternal fever, and insufficient prenatal care were the probable risk factors associated with neonatal sepsis.
Introducción: la sepsis es una de las principales causas de morbimortalidad en neonatos. Objetivo: identificar los factores de riesgo para sepsis neonatal en una unidad de neonatología durante los meses de marzo a octubre del año 2016. Métodos: estudio de casos y controles. Los factores analizados fueron: a) factores neonatales como: tipo de parto, sexo, peso al nacimiento, edad gestacional, criterios de síndrome de respuesta inflamatoria sistémica, tipo de sepsis (temprana o tardía) y resultado de hemocultivo; b) métodos invasivos como: cateterismo central, nutrición parenteral total, cateterismo umbilical y ventilación mecánica y; c) factores maternos como: número de controles prenatales, infección durante el embarazo, ruptura prematura de membranas, edad materna y fiebre materna. Se utilizó razón de momios (RM) para determinar asociación. Resultados: para el desarrollo de sepsis temprana, los factores de riesgo significativos fueron: el desequilibrio termodinámico, la taquicardia y la fiebre materna. Respecto a la sepsis tardía se encontraron asociaciones significativas para el desequilibrio termodinámico, el uso de cateterismo umbilical, la ventilación mecánica y los controles prenatales insuficientes. Conclusión: el desequilibrio termodinámico, la taquicardia, la ventilación mecánica, el cateterismo umbilical, la fiebre materna y los controles prenatales insuficientes fueron los probables factores de riesgo significativos asociados a sepsis neonatal.