Saúde perinatal

Abstract

As infant mortality has been reduced, the deaths of children of less than one year of age have come to be concentrated in the weeks nearer birth, and the so-called "neonatal mortality" (during the first 28 days of life) has come to account, practically alone, for almost all infant deaths. This is what has been observed in developed countries or areas and, with the increase of that reduction the deaths have become even more concentrated, occuring almost exclusively during the first week of life (the early neonatal period). This is precisely what is observed in countries where infant mortality has already reached figures lower than 10 per 1,000 live-births, in some cases the figures reaching values lower than 7 per 1,000. Both early neonatal deaths and late fetal deaths (stillbirths) are due to the same causes and factors, thence the importance of studying them together, which group constitutes what have come to be called "perinatal deaths", that is, those deaths occuring in the perinatal period. The term "perinatal" was proposed by Peller in 1940, who considered it necessary to analyse, as a single "statistical unit", the sum of stillbirths and the deaths occuring during the first postnatal week. In a 1965 publication this author wrote:.. . "Stillbirths and deaths which occur within a few days after birth have in common a complex of causes which differ from the pattern in older infants. For this reason, and because of customs, religious attitudes and laws concerning registration of birth which hampered international comparisons, 1 have since 1923 considered it necessary to analyse as one statistical unit the sum of stillbirths (late fetal deaths) and deaths during the first week ... in the 1940's 1 suggested that this unit be termed perinatal mortality. .. The term caught on in the early 1950's". In order better to realize the importance of understanding what occurs in this period, it is interesting to note that in many countries at the present time, the number of perinatal deaths excedes that observed during the following 30 years, even though the perinatal period represents less than 0.5% of the average life span. In Brazil, as well as in other countries where infant mortality stands high, it is important to know the causes and factors responsible for perinatal mortality. This, among us, reaches a very considerable figure, being much higher than that observed in developed areas, although it is relatively less important when compared to the infant mortality rates as a whole. Indeed, in countries where infant mortality falls between values of 8 and 15 per 1,000 live-births, perinatal mortality attains a rate of between 12 and 20 per 1,000 live-births and stillbirths. While infant mortality in the municipality of São Paulo, Brazil, was near 90 per 1,000 in 1976, and perinatal mortality was 40.5 per 1,000, these figures became, respectively, 52.4 and 28.8 per 1,000 in 1981. Although we are in the phase of reducing the so-called "exogenous causes" of infant mortality, it is important to have a profound knowledge of t...

A Obra Prima: a arte de cuidar no início da vida

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