Atención de la salud en niños de muy bajo peso al nacer en Montevideo,Uruguay: comparación entre los sectores publico y privado

Abstract

ResumenObjetivo: comparar morbilidad y mortalidad de los niños de muy bajo peso al nacer de Montevideo, Uruguay, atendidos en unidades intensivas del sector público y privado.Metodología: delineamiento longitudinal. Se incluyeron los recién nacidos de muy bajo peso al nacer del sector público de la ciudad de Montevideo, Uruguay, nacidos desde el 1/5 al 31/10/1999, siguiéndose hasta su alta o muerte. Se comparó atención recibida, morbilidad y mortalidad entre los trasladados inmediatamente al nacimiento a unidades de cuidados intensivos neonatales privadas con los que permanecieron en unidades públicas sin haber sido nunca trasladados.Resultados: nacieron 141 niños de muy bajo peso al nacer. Se excluyeron del estudio 19 niños (13 murieron en sala de partos y 6 nacidos en el sector público trasladados a unidades intensivas públicas). De los 122 niños incluidos, 61 quedaron en la unidad del hospital público en que nacieron y 61 fueron referidos a unidades privadas. Los atendidos en el sector privado resultaron más prematuros y con mayor frecuencia de depresión neonatal. Sin embargo, la mortalidad en el sector público fue casi dos veces mayor (Hazard Ratio 1.8, IC 95% 1.1-3.4, p=0,04), fundamentalmente en los menores de 1000 gramos (Hazard Ratio 2.4, IC 95% 1.1-5.5, p=0,04).Conclusión: se realizó una evaluación de la atención de los niños de muy bajo peso atendidos en unidades intensivas públicas y privadas de Montevideo, Uruguay. Hubo menor mortalidad en los niños atendidos en el sector privado y algunas evidencias de que la calidad de atención es mejor en éste sector. AbstractObjective: to compare morbidity and mortality in very low birthweight infants admitted to public and private intensive care units in Montevideo, Uruguay.Methods: longitudinal design. All very low birth weight infants born in public hospitals of Montevideo between May 1st and October 31st, 1999, were included in the study and followed up until they were discharged from hospital, or died. The quality of care, and morbidity and mortality rates obtained in private intensive care units were compared with those observed in public intensive care units (infants who were never transferred).Results: of 141 infants, 19 were excluded from the study (13 died at the delivery room and six were transferred to intensive care units of other public hospitals). Of the remaining 122 infants, 61 were kept at the intensive care units of public hospitals, and 61 were transferred to a private unit. The infants who were transferred presented lower gestational age and increased neonatal depression. However, mortality among infants treated at intensive care units of public hospitals was twice as high (Hazard Ratio 1.8; 95%CI 1.1-3.4; P=0.04), especially in infants who weighed less than 1,000g (Hazard Ratio 2.4; 95%CI 1.1-5.5; P=0.04).Conclusions: the health status of very low birth weight infants treated at intensive care units of public and private hospitals in Montevideo, Uruguay, was assessed. Mortality was lower, and health care was better in neonatal units of priv...

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