Near miss neonatal precoce identificado com base em sistemas de informação em saúde

Abstract

The aim of this study was to validate a definition to identify cases of early neonatal near miss using data from health information systems (SIS in Portuguese). This was a concurrent validation study focusing on three definitions for identification of cases of early neonatal near miss among live births in a university hospital in 2012. Three different definitions were applied to this live birth cohort using the criteria birth weight, gestational age, 5-minute Apgar score, admission to the neonatal intensive care unit, mechanical ventilation, and congenital malformations, in different combinations, considering the proposals in two Brazilian articles (Silva et al.; Pillegi-Castro et al.) and a third (SIS definition) with available data from health information systems. Cases were defined as infants that had survived the risk conditions as of the 7th day of life. For concurrent validation, the study adopted early neonatal deaths as the reference. Of the 2,097 live births studied, 33 died in the early neonatal period, and the number of cases of early neonatal near miss varied according to the definition used: 153 (Silva definition), 194 (Pileggi-Castro definition), and 304 (SIS definition). Sensitivity and specificity were 97% and 92.6%, respectively, according to the Silva definition, 90.9% and 90.6% according to the Pileggi-Castro definition, and 93.9% and 85.3% according to the SIS definition. The results show that the SIS definition has sensitivity and specificity close to the other definitions and suggest that it is possible to monitor early neonatal near miss using only data that are available in official health information systems.

Early Neonatal Near Miss in a University Hospital: Comparative Cross-Sectional Study

“…15 We considered early neonatal near misses the live births that presented any of the following risk conditions at birth: gestational age <33 weeks, birth weight <1,750 g, 5-minute Apgar score <7, or NICU admission, and were alive until the 7 th day of life. 11 Data from 2012 and 2016 were collected from the State Health Department: those related to live births were obtained from the Live Birth Information System (Sistema de Informações de Nascidos Vivos -Sinasc) and to early neonatal deaths, from the Mortality Information System (Sistema de Informação sobre Mortalidade -SIM). We used data from the SUS Hospital Information System (Sistema de Informações Hospitalares do SUS -SIH-SUS) to obtain the information on the NICU admission criteria, through the analysis of the hospital admission authorization copy of each hospitalized newborn.…”

“…7,8 They generally represent from three to ten times the number of neonatal deaths. [9][10][11] Operational definitions of neonatal near miss, although not consensual, 5,8 are generally based on pragmatic criteria: birth weight, gestational age, and 5-minute Apgar score. 7,11,12 Other definitions are associated with the management variables used to save the baby's life, such as blood transfusion, surfactant use, phototherapy, mechanical ventilation, etc.…”

“…[9][10][11] Operational definitions of neonatal near miss, although not consensual, 5,8 are generally based on pragmatic criteria: birth weight, gestational age, and 5-minute Apgar score. 7,11,12 Other definitions are associated with the management variables used to save the baby's life, such as blood transfusion, surfactant use, phototherapy, mechanical ventilation, etc. 13,14 The use of neonatal near miss definitions to monitor care outcomes in health facilities is a challenge, but it can be easier with the variables available in the information systems maintained in daily services.…”

“…13,14 The use of neonatal near miss definitions to monitor care outcomes in health facilities is a challenge, but it can be easier with the variables available in the information systems maintained in daily services. 11,12 Neonatal near miss indicators are used for diagnosis, monitoring, and evaluation of neonatal hospital care and make it possible to compare the same or different health facilities over time. 7,9 The surveillance of neonatal near misses and the monitoring of their indicators may reveal weaknesses in health care and favor the promotion of public policies aimed at women, pregnant women, and newborns.…”

“…7,9 The surveillance of neonatal near misses and the monitoring of their indicators may reveal weaknesses in health care and favor the promotion of public policies aimed at women, pregnant women, and newborns. 11 Thus, the study aimed to compare 2012 and 2016 data on early neonatal near miss indicators from Health Information Systems in a university hospital.…”