Coorte nascer prematuro: near miss neonatal e hipotermia em unidades de terapia intensiva

Abstract

Prematurity represents a serious public health problem, as it is the leading cause of death in newborns and the second leading cause of all infant deaths in the world. We consider all newborns to be vulnerable; nowadays, those born prematurely are more fragile as they require special care to stay alive. Furthermore, surviving premature infants represent a group that requires greater assistance when they present indicators of severity. In this context, two studies were conducted using data from the “Nascer Prematuro” cohort with an analysis of 400 medical records of premature newborns admitted to the Neonatal Intensive Care Unit (NICU) in Vitória da Conquista – Bahia, over two years (2016 to 2017). Study 1: This study aimed to analyze gestational hypertensive syndromes (GHS) as a distal risk factor associated with admission hypothermia in premature infants admitted to the NICU. Preterm infants with an admission temperature lower than or equal to 36.4°C were considered to have hypothermia, being categorized as mild hypothermia (temperature between 36.0–36.4°C) and moderate (between 32.0–35.9° C) C). The association between SHG and hypothermia was assessed using multinomial logistic regression. In the 313 selected records, admission hypothermia was recommended in 62.0%, 35.5% being moderate hypothermia and 26.5% mild. Gestational hypertensive syndromes were identified in 35.5% of mothers. SHG have been shown to increase the chance of moderate hypothermia (OR: 1.97; 95% CI: 1.14-3.39). Preterm infants with birth weight less than 1,500g (OR 2.61; 95%CI 1.53-4.44), with gestational age less than 32 weeks (OR 2.08; 95%CI 1.23-3.52), and who required resuscitation maneuvers at birth (OR 1.93; 95% CI 1.14-3.28) were also more exposed to moderate hypothermia. Mild hypothermia was not associated with SHG. Study 2: The objective was to investigate the early neonatal near-miss indicator in hospitalized premature infants, as well as the care received at birth and the complications occurring in premature infants with this indicator. The main outcome was the occurrence of early neonatal near miss, defined by preterm birth that occurred at least 1 stratified severity: gestational age less than 33 weeks, birth weight below 1750 g, and Apgar score < 7 in the fifth minute of life. The variables related to care were resuscitation maneuvers, the use of CPAP (Continuous Positive Airway Pressure), and inhaled oxygen. The stages of early sepsis and death were also verified. The variables were described using absolute and relative frequencies. Bivariate analysis was performed using Pearson's chi-square and Fisher's exact tests to verify associations between outcomes and variables. 234 cases of early neonatal near miss and 31 early neonatal deaths were identified. Among the cases of early neonatal near miss, the majority (52.6%) presented two severity criteria. The severity criteria were significantly associated (p<0.05) with cases of early neonatal near miss and also with early neonatal deaths. Preterm infants with early neonatal near miss had a greater need for resuscitation (50.8%) and inhaled oxygen (18.1%) when compared to those without serious injuries. They also had higher frequencies of early neonatal sepsis (70.1%), neonatal (8.1%), and post-neonatal (6.1%) deaths. It was concluded that premature graves were identified by the early neonatal near miss, which presented a greater risk for unfavorable developments such as morbidities and deaths.