Perinatal Care in a Northeastern Brazilian State: Structure, Work Processes, and Evaluation of the Components of Essential Newborn Care

Abstract

Objective: To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. Methods: A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants’ records, were also analyzed. Results: Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. Conclusions: The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.

Coronavirus disease‐19 deaths among children and adolescents in an area of Northeast, Brazil: why so many?

“…One study has described the direct and indirect effects of the pandemic in the health services available for neonates in low-and middle-income countries [21] Sergipe has historically had high mortality rates among its neonates [12] COVID-19-related deaths in Sergipe may have highlighted these discrepancies in the Brazilian SUS, especially for services such as maternal and neonatal care that have a history of inadequate supplies and services [22,23] The role of comorbidities in severe COVID-19 has been reported less frequently in children than in adults. In Europe, COVID-19 deaths occur less frequently in children, even among those who are immunocompromised [24].…”

Perinatal Care in a Northeastern Brazilian State: Structure, Work Processes, and Evaluation of Essential Newborn Care Components

“…Despite showing data above the national average on aspects such as the presence of an on-duty pediatrician 24 hours a day and the availability of equipment for maternal and neonatal resuscitation in all maternity hospitals, the state still has deficits in several essential newborn care (ENC) measures. 1 …”

“…Therefore, this letter aims at providing data from other Brazilian states in order to encourage improvements in actions for newborn care proposed by the World Health Organization (WHO). 1 …”

“…The poor prevalence of breastfeeding in the first hour of life portrays the reality not only of this Northeastern state but also of Brazil. 1 …”

“…One of the paradoxes presented in our article is the presence of an adequate hospital structure for perinatal care (equipment for resuscitation and pediatricians in the delivery room, for example) associated with the low frequency of breastfeeding in the first hour of life and early skin-to-skin contact. 1 …”