Nascer em Belo Horizonte: desfechos neonatais desfavoráveis

Abstract

Introduction: Brazil has achieved in recent decades, important advances in public policy with positive impacts on maternal and child health. Although the country has already achieved the mark of the Millennium Development Goals for infant mortality, some indicators still remain at a disadvantage, including prematurity, low birth weight and morbidity resulting from these situations. These problems have been associated with excessive medicalization of childbirth care and birth, translated especially in the high cesarean rates in the country. Objective: To analyze the occurrence of adverse neonatal outcomes in children born in Belo Horizonte second determining maternal, neonatal and assistance and to identify events that characterize the neonatal near miss. Methods: This was a cohort study conducted in public and private maternity hospitals in Belo Horizonte, Minas Gerais, from November 2011 to March 2013. The sample consisted of mothers hospitalized for hospital birth of reason and its newborn regardless of weight and gestational age, and when dead weighing more than 500 grams and gestational age greater than 22 weeks. Univariate analysis was performed to assess the association between risk factors and outcomes prematurity, low birth weight and adverse neonatal outcome. The extraction of the final models was performed by logistic regression. Results: Were evaluated in 1088 newborns. Some unfavorable neonatal outcome was seen in more than a third of newborns, especially premature birth and low birth weight (about 10% each), resuscitation in the delivery room (19,1%), the use of oxygen after birth (12%) and hospitalization in units neonatal intensive care (7.1%). In the model of prematurity, the variables number of prenatal consultations, cesarean section, previous preterm infant, economy class D or E and clinical complications in the current pregnancy were significant to the outcome. For low birth weight, the variables associated significantly and remained in the model were the number of prenatal consultations, cesarean section, twin pregnancy and clinical complications during the pregnancy. In the newborn model with adverse neonatal outcome, presenting clinical complications during the pregnancy was a risk factor, whereas health insurance and prenatal card were protective factors for the outcome. For the neonatal near miss morbidity indicator variables highly associated with neonatal mortality were gestational age, Apgar score less than 7 at 5 minutes and holding the majority of prenatal appointments in the public service and in private. Conclusions: Despite the advances noted in maternal and child health, the occurrence of adverse neonatal outcomes in newborns of Belo Horizonte is still a challenge to be overcome and preventive health measures should pervade the whole process of pregnancy and childbirth.