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Despite technological progress in recent decades, neonatal mortality accounts for some two-thirds of infant deaths where the infant mortality rates are low. This study analyzes neonatal deaths in Londrina, Paraná, Brazil, during three periods, beginning with 1994, the year when pediatric and neonatal intensive care beds were created in the city. The data were collected from live birth certificates in the National Information System on Live Births (SINASC) and individual analysis of neonatal death certificates. Births declined in the city, but the low birthweight rate increased from 7.7 to 8.8% and the preterm birth rate from 6.3 to 8.4%. Multiple births also increased. Caesarian sections varied from 48 to 52%. The percentage of deaths from congenital malformations increased. The vast majority of neonatal deaths are preventable, mainly by providing specialized care during pregnancy. The neonatal mortality rate has declined recently, from 10.1 to 6.4 per 1,000 live births. The authors conclude that neonatal care is improving in Londrina.

OBJETIVO: Analisar a mortalidade intra-hospitalar dos recém-nascidos de muito baixo peso, considerando a evolução clínica e os fatores associados à mortalidade. MÉTODOS: Estudo longitudinal que incluiu 360 recém-nascidos com peso entre 500 e 1.500g, em Londrina, Paraná, de 1/1/2002 a 30/6/2004. Os dados foram coletados por meio de entrevistas com as mães, análise dos prontuários e acompanhamento dos recém-nascidos. Para determinação de associação entre as variáveis utilizou-se o teste do qui-quadrado e análise de regressão logística com modelo hierarquizado, com nível de significância de 5%. RESULTADOS: A taxa de mortalidade foi de 32,5%. Na análise bivariada, as variáveis associadas ao óbito oram: não uso de corticosteróide antenatal, ausência de hipertensão arterial/pré-eclampsia, presença de trabalho de parto, parto normal, apresentação não cefálica, Apgar < 3 no primeiro e quinto minutos, Clinical Risk Index for Babies > 5, reanimação na sala de parto, sexo masculino, idade gestacional < 28 semanas, peso < 750g, síndrome do desconforto respiratório, pneumotórax, hemorragia intracraniana e ventilação mecânica. Após regressão logística, permaneceram como fatores de risco: baixa renda per capita, não uso de corticosteróide antenatal e não uso de pressão positiva contínua de vias aéreas. CONCLUSÕES: Mesmo com o uso de tecnologias, a mortalidade observada nos recém-nascidos de muito baixo peso foi alta quando comparada com os países desenvolvidos. A maior utilização do corticosteróide antenatal poderá diminuir a morbidade e mortalidade de recém-nascidos de muito baixo peso.

ObjectiveTo evaluate the mortality rate of very low birth weight babies born at a Neonatal Intensive Care Unit (NICU) during a specified period of time according to variations in CRIB (Clinical Risk Index for Babies) score, birth weight and gestational age. MethodsFrom January 1997 to December 2000, the CRIB score was prospectively applied to all newborn infants admitted to the N ICU of an university hospital, of Londrina, Brazil, with birthweight under 1,500 g and/or less than 31 weeks' gestational age. The exclusion criteria were: death before 12 hours of life, presence of lethal congenital malformations and newborns who had been referred from other hospitals. ResultsTwo hundred and eighty-four infants met the inclusion criteria. Mean birth weight was 1,148±248 g (median =1,180), mean gestational age was 30.2±2.4 weeks (median =30.0) and mean CRIB score was 3.8±4.4 (median =2.0). The neonatal mortality rate was 23.2%, varying according to mean birthweight <750 g (72.7%), gestational age <29 weeks (57.1%) and CRIB score >10 (79.4%). Receiver Operating Characteristic (ROC) curves were composed for CRIB score, birth weight and gestational age to assess the ability of each to predict hospital mortality and the areas under the curve were respectively 0.88, 0.76 and 0.81. Sensitivity, specificity and predictive values were evaluated and all variables were considered predictors of mortality (p<0.0001). The optimal cut off point based on the ROC curve for the CRIB score was 4 with sensitivity 75.8%, specificity 86.7, positive predictive value 63.3% and negative predictive value 92.2%. ConclusionsIn this study infants with birthweight of less than 750 grams, less than 29 weeks gestational age and CRIB scores above 10 had higher mortality rates. However, a CRIB score higher than 4 proved to be a better predictor of mortality when compared to birthweight and gestational age.

RESUMO.O leite materno é o alimento completo para o crescimento e desenvolvimento da criança até o 6 mês de vida. O objetivo deste estudo foi avaliar a prevalência do aleitamento materno na cidade de Maringá (PR) até o 6° mês de idade e caracterizar as mães quanto a variáveis socioeconômicas e demográficas, à assistência pré-natal e natal, às características dos recém-nascidos; verificar a associação do AM exclusivo até o 4° mês com as variáveis e analisar a duração do aleitamento materno exclusivo, completo e aleitamento materno até o 6° mês. Foi realizado um estudo transversal por meio de inquérito domiciliar, com uma amostra de 373 crianças, através de questionário, para caracterizá-las de acordo com as variáveis e analisar o tipo e a duração do AM até o 6° mês de idade. Também foram estudadas as variáveis associadas ao AM exclusivo até o 4° mês. Na análise da duração do AM, foi utilizada a curva de Kaplan-Meier. A prevalência do AM ao 4 e 6 meses foi respectivamente de 60,3% e 54,9%. Quanto ao AM exclusivo, a prevalência foi de 14,2% e 9,5% aos 4 e 6 meses. Encontramos associação positiva com AM exclusivo no 4° mês às variáveis: situação conjugal com vínculo, recém-nascidos com idade gestacional abaixo de 37 semanas e mães com experiência anterior em amamentação.Palavras-chave: prevalência, aleitamento materno.ABSTRACT. Prevalence of breast-feeding in infants up to six months old, in Maringá, state of Paraná, Brazil. The maternal milk is the complete food for child's growth and development until the sixth month of life. The objective of this study is to evaluate the prevalence of breast-feeding in Maringá city, state of Paraná (PR) until the 6 th month and to characterize the mothers regarding social, economical and demographic variables, prenatal and natal assistance, newly born children characteristics. Also, to verify the association of exclusive breast-feeding until the 4 th month with the variables and to analyze the duration of the exclusive complete breast-feeding as well as the breast-feeding until the 6 th month. A traverse study was accomplished by means of inquiry domicile, with a sample of 373 children, through questionnaire, to characterize them according to the variables and to analyze the type and duration of breast-feeding until the 6 th month. The variables, associated with exclusive breast-feeding until the 4 th month, were also studied. In the analysis of breast-feeding duration, the curve of Kaplan-Meier was used. The prevalence of breast-feeding at 4 and 6 months was 60.3% and 54.9%, respectively. In relation to exclusive breast-feeding, the prevalence was 14.2% and 9.5% at 4 and 6 months. We found positive association with exclusive breast-feeding in the 4 th month to the variables: married situation with bond, newly born with pregnancy age below 37 weeks and mothers with previous experience in breast-feeding.

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