A mortalidade do prematuro extremo em nosso meio: realidade e desafios

Abstract

Suggested citation: de Carvalho M, Gomes MA. Mortality of very low birth weight preterm infants in Brazil: reality and challenges. J Pediatr (Rio J). 2005;81(1 Suppl):S111-S118. AbstractObjective: The objective of this article is to review and discuss the medical literature on epidemiological indicators and organizational structure of the Brazilian perinatal health system concerning the care of very low birth weight premature infants (< 1,500 g).Sources of data: Electronic search of the MEDLINE, Lilacs and SciELO databases from 1990 to 2004, with a selection made of the most relevant articles. Documents and reports from the Ministry of Health (Mortality Information System SIM and Live Births Information System SINASC). Summary of the findings:The decrease in infant mortality rates and the high incidence of maternal deaths, observed since 1990, prompted de Brazilian government to focus its strategies on the organization and delivery of care to pregnant women and their newborn infants. However, a critical analysis of the actions aimed at the care of premature infants reveals that the coverage and utilization of these services are not uniform and that the records on birth and death rates are not reliable. The availability of neonatal beds is very limited and does not meet the demand, especially for those requiring high levels of complexity. Important challenges must be overcome to adequately deal with the incorporation of inappropriate technology, the limited number of qualified health professionals and utilization of evidence-based best practices to improve perinatal care. Conclusions:A reduction in the rates of morbidity and mortality of premature infants requires more effective planning and intervention in the prenatal care system. To meet the demand, increases in the number of neonatal intensive care beds should be implemented through specialized perinatal centers rather than isolated beds within hospitals of with low resolution rates. These centers should be interconnected and their practices constantly monitored and evaluated.J Pediatr (Rio J). 2005;81(1 Suppl):S111-S118: Neonatal mortality rate, premature infants, low birth weight, perinatal care.

O cuidado da criança prematura no domicílio

“…In this sense, perinatal care involves: countless difficulties, instead of guaranteed access; inequality, where there should be equality; disorganization and fragmentation, instead of system hierarchy and regionalization; as well as frequent and concerning technical-scientific inadequacies. These, as a result, represent challenges for public management of this type of care (20) .…”

Fatores determinantes da mortalidade neonatal em um município da Região Sul do Brasil

“…Neonatal deaths correspond to 65% of all childhood deaths under one year of age. This evidence also refers to improved no fi ca on in the ministerial databases (1)(2)(3)(4) .…”

“…Both regions also reduced the number of births in the same period (3,4) . Although in some Brazilian states neonatal mortality rates are in the process of reduc on and/or stagna on, nevertheless, several studies have shown that the majority of these deaths are strongly linked to socioeconomic dispar es and access to health services, in addi on to biological condi ons, such as: birth weight, Apgar score and gesta onal age (1,(7)(8)(9)(10)(11)(12) .…”

Vivência de enfermeira no cuidado transpessoal às famílias de neonatos egressos da unidade de terapia intensiva

“…Taking into account the principle that neonatal care is not limited to guaranteeing the survival of extremely premature infant until discharge, it is clear that the monitoring and adequate support for babies and children discharged from neonatal units are still huge challenges in our area (5) . Thus, it is necessary to invest our attention to the moments after hospital discharge, following up those children in ambulatory clinics, health units and at home.…”