Objective:To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns. Method: This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013. Results: Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death. Conclusion: Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality. . If we break down infant mortality by age, worldwide, neonatal (0 to 27 days) deaths account for 44% of all deaths among children under the age of five (3) . In Brazil this component is even larger, and can be as high as 70% in all regions (2) , with 11.2 deaths per thousand live births between 2011 and 2012 (4) . In the state of Paraná, neonatal deaths dropped from 2,426 in 1996 to 1,279 in 2014 (94.8% less). However, in spite of all the progress made, 71.8% of infant deaths in 2014 were in the neonatal period (5) . According to the Report on Levels and Trends in Infant Mortality (Relatório de Níveis e Tendência em Mortalidade Infantil), the main goal is to reduce mortality in the neonatal period, which is where most infant deaths occur (1) . To reduce maternal and infant mortality, and the high percentage of avoidable deaths, in 2012 a public policy for prenatal care and for the care of newborns at risk was created in Paraná. It focuses on early detection of pregnant women at risk, their prenatal care, risk stratification of mothers and infants, specialized ambulatory care for pregnant women and infants (under the age of one) at risk, and ensured delivery via a system that is linked to the hospital (6) . Numerous studies have attempted to analyze the causes of neonatal deaths. Studies show a strong link between neonatal deaths and maternal and infant life conditions and health, economic situation, and access to healthcare, and to biological conditions such as gestational age, weight at birth and Apgar index (7) . We also call attention to the risk in the current and previous pregnancy (prior stillbirth, premature or low birth weight infants), the movement of the pregnant woman to delivery and women giving birth to low-weight babies (< 1,500 grams) in hospitals not equipped with a Neonatal Intensive Care Unit (NICU) (4) . Studies show that among newborns in NICU, Cesarean birth, failure to use steroids, pre-eclampsia, oligohydramnios, <2,500 grams ...

Objetivo: Evaluar el conocimiento y la práctica sobre la lactancia materna en la primera hora de vida entre los miembros del equipo multidisciplinario de un hospital en la ciudad de Maringá, Paraná.Metodología: Estudio descriptivo-exploratorio con enfoque cualitativo. Los datos fueron recolectados entre octubre y noviembre del 2013 mediante entrevistas grabadas con 11 participantes. Para el procesamiento de los datos, se utilizó la técnica de análisis de contenido.Resultados: Se encontró que los profesionales de la salud tienen deficiencias en el conocimiento acerca de la lactancia materna en la primera hora de vida; además, la práctica no suele realizarse en la institución, a partir de lo cual surgen desafíos y recomendaciones para establecer esta actividad.Conclusiones: Se sugiere incluir esta práctica en las políticas del hospital para la promoción y protección de la lactancia materna, que consoliden el equipo multidisciplinario y el trabajo colaborativo entre sus miembros.

RESUMOEsta pesquisa teve como objetivo analisar os resultados perinatais de gestantes de alto risco com síndrome hipertensiva. Estudo transversal, de base documental, com 920 prontuários de gestantes de um ambulatório de alto risco. A variável independente foi a síndrome hipertensiva, considerando a hipertensão arterial como condições preexistentes, pré-eclâmpsia como antecedente obstétrico e doença hipertensiva específica da gestação (DHEG) como intercorrência clínica. As variáveis dependentes foram prematuridade, baixo peso ao nascer, Apgar inferior a sete no 1° e 5° minutos, morte fetal, morte infantil, parto normal e parto cesáreo. Para analisar a associação entre as variáveis, utilizou-se o teste qui-quadrado e comparou-se o risco relativo no intervalo de confiança (IC) a 95%. Da amostra estudada, 25,32% apresentaram síndrome hipertensiva; 14,36% foram classificadas com hipertensão arterial (grupo 1), 6,73% com pré-eclâmpsia (grupo 2); 4,02% apresentaram DHEG (grupo 3); e 30,65% eram normotensas (grupo 4). No grupo 1 constatou-se risco elevado para morte fetal e o parto normal foi fator de proteção. No grupo 2 verificou-se risco elevado para parto cesáreo. No grupo 3, constituiu risco elevado para prematuridade e baixo peso ao nascer. Os três grupos apresentaram risco elevado para Apgar baixo no 1º e 5º minuto. As síndromes hipertensivas na gestação relacionaram-se a resultados perinatais desfavoráveis, evidenciando a necessidade de cuidados especializados à gestante, por meio de um pré-natal especializado e de qualidade. Palavras-chave: Saúde Materno-Infantil; Complicações na Gravidez; Gravidez de Alto Risco; Hipertensão. ABSTR ACT This study aimed to analyze the perinatal outcomes of high risk pregnancies of women with hypertensive syndrome. It was a cross-sectional study, with a documental basis, with 920 records of pregnant women from a high-risk outpatient clinic. The independent variable was hypertensive syndrome, considering arterial hypertension as pre-existing conditions, pre-eclampsia as obstetric antecedents and heart disease of pregnancy (HDP) as clinical complications. The dependent variables were prematurity, low birth weight, Apgar score below than seven in the 1st and 5th minutes of life, fetal death, infant death, normal delivery and cesarean delivery. To analyze the association between the variables, the Chi-square test was used and Relative Risk was compared in the 95% confidence interval (CI

Objetivo: analisar as repercussões perinatais do uso de drogas por gestantes atendidas em um ambulatório de alto risco. Método: estudo caso-controle, no qual foram avaliados 920 prontuários, no período de 2012-2013. O grupo caso foi constituído pelas gestantes usuárias de drogas lícitas/ilícitas (41) e o controle por gestantes de risco não usuárias (82). Resultados: as gestantes usuárias apresentaram risco aumentado para prematuridade (RR=2,64, p=0,02), baixo peso ao nascer (RR=5,42, p=0,01) e baixo índice de Apgar no 1º minuto (RR=2,97, p=0,01). Conclusão: os resultados indicam que gestantes usuárias de drogas apresentam desfechos perinatais desfavoráveis à gestação.

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Objective: To analyze the association between gestational risk factors and type of delivery in high-risk pregnancies. Method: A cross-sectional epidemiological study involving a retrospective analysis of secondary data from 4,293 medical records of high-risk pregnant women. The primary outcome was composed of risks associated with cesarean delivery and spontaneous abortion compared with normal delivery. Results: There were 3,448 women analyzed in the study. The primary outcome rates were cesarean delivery (72.8%), spontaneous abortion (0.9%) versus vaginal delivery (26.2%). Common risk factors for cesarean delivery and spontaneous abortion were age ≥35 years (OR = 1.4; 95% CI 1.1-1.7 / OR = 11.5; 95% CI 4.2-31.0), evangelical religion (OR = 1.4; 95% CI 1.2-1.7 / OR = 2.6; 95% CI 1.0-6.7), high blood pressure (OR = 1.4; 95% CI 1.1-1.8 / OR = 74.9; 95% CI 13.7-410.2) and twinning (OR = 3.1; 95% CI 1.9-5.0 / OR = 68.6, 95% CI 9.7-487.7). Conclusion: Identifying the relationship of gestational risks with the type of delivery and abortion can contribute to developing strategies and assist in planning actions in women’s healthcare networks, developing specific and individualized lines of care for each gestational risk.

Objetivo: Analisar a presença de condições de riscos e sua relação com as características sociodemográficas de gestantes atendidas em um ambulatório especializado do sul do Brasil. Métodos: Estudo exploratório, descritivo, de abordagem quantitativa, realizado a partir de prontuários de 920 gestantes acompanhadas no pré-natal de alto risco. As variáveis desfechos foram: condições pré-existentes, antecedentes obstétricos e intercorrências clínicas e as variáveis independentes foram características sociodemográficas da mulher.  Resultados: Mulheres com 36 anos ou mais apresentaram associação significativa para hipertensão (28,8%), endocrinopatias (20,6%), mioma uterino (6,9%) e mais de três cesáreas (6,9%). A baixa escolaridade esteve associada com hipertensão (25,0%), epilepsia (6,4%), mais de três cesáreas (10,8%) e gemelaridade (10,8%). Conclusão: Identificaram-se associações entre o perfil sociodemográfico com condições clínicas pré-existentes, antecedentes obstétricos e intercorrências clínicas na gestação de alto risco, atribuindo aos ambulatórios especializados a necessidade de realizar ações para minimizar os desfechos desfavoráveis e melhorar a qualidade dos serviços.

The present study presents binary data modeling regarding 1.6% of neonatal deaths in 3,448 newborns from an epidemiological and observational study with a cross-sectional design, involving the retrospective analysis of 4,293 medical records of high-risk pregnant women followed in a gestational outpatient clinic from September 2012 to September 2017. Different symmetric and asymmetric link functions were considered by means of Bayesian inference. The support of more accurate inferences regarding the parameters of the model will provide biological interpretations that are more reliable and consistent with the reality. The model that presented, significantly, the lowest value for the deviance information criterion (DIC = 398.8), was the binomial with power logit (PL) link function, whose median posterior value estimated and significant for the parameter asymmetry was l = 0.25 (0.14;1.17). This significance is observed in all other models of the power family, however with very different values ​​and significantly higher DIC values, indicating less parsimonious models. The Bayesian methodology proved to be flexible. Additionally, the results show that such model shows an accuracy = 97.4% and area under the ROC curve AUC = 89.4% in the prediction of neonatal deaths based on the weight of children at birth. Specifically, for 2.500g, a value predicted in the medical literature for low weight, the model predicts a probability of 1.43%.