Fatores de risco para morbimortalidade precoce em recém-nascidos com obstrução duodenal congênita intrínseca: uma análise multivariada

Abstract

The aim of this study was to identify predictors of early morbidity andmortality in neonates with congenital intrinsic duodenal obstruction. All children with congenital intrinsic duodenal obstruction operated at the Hospital das Clínicas, Universidade Federal de Minas Gerais, were reviewed. Data were evaluated using the Cox regression model and logistic regression. From 1983 to 2007, 56 children born with congenital intrinsic duodenal obstruction were operated, including 47 neonates, the sample of this study. Overall mortality was 21,3%. Neonates with verylow birth weight (<1500g) presented a higher mortality risk (seven-fold) than those newborns weighting >1500g and even a higher one (14-fold) than those children weighting >2500g. Babies without prenatal diagnosis of duodenal obstruction were more likely to be refered from other hospitals (p=0,001), delaying admission and operation (p=0,002), which further increased the risk of nutritional/digestive complications (OR: 4,1). In neonates with associated congenital heart disease there was an increased risk of cardiovascular complications (OR=38). The frequency ofcongenital heart disease was higher (p=0,001) in children with Down syndrome. Isolated Down syndrome did not increase morbidity or mortality rates. Ventilatory complications were more common in newborns with an initial Apgar score below seven points (OR:13). Low Apgar scores and very low birth weight (<1500g) are well known neonatal risk factors, and also increased morbidity and mortality in this seriesof newborns with congenital intrinsic duodenal obstruction. Prenatal diagnosis of duodenal obstruction did not influence mortality, but allowed earlier admission and operation, reducing the frequency of digestive and nutritional complications. Neonates with associated Down syndrome, without congenital heart disease, had a similar prognosis when compared to children without this trissomy.