Óbitos neonatais precoces associados à asfixia perinatal em neonatos ≥2.500 g no Brasil

Objective: To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing >= 2500 g in Brazil from 2005 to 2010. Methods: The population study enrolled all live births of infants with birth weight >= 2500 g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases, 10th Revision (P20.0, P21.0, and P24.0). An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year. Results: A total of 10,675 infants weighing >= 2500 g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24 h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38%) of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (p < 0.001); the meconium aspiration syndrome-specific early neonatal mortality ratio remained between 0.20 and 0.29 per 1000 live births during the study period. Conclusions: Despite the decreasing rates in Brazil from 2005 to 2010, early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight andwithout congenital malformations are still high, and meconium aspiration syndrome plays a major role. (c) 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.Objetivo: Avaliar a taxa anual de óbitos neonatais precoces associados à asfixia perinatal em neonatos de peso ≥ 2.500 g no Brasil de 2005 a 2010. Métodos: A população do estudo envolveu todos os nascidos vivos de neonatos com peso ao nascer ≥ 2.500 g e sem malformações que morreram até seis dias após o nascimento por asfixia perinatal, definida como hipóxia intrauterina, asfixia no nascimento ou síndrome de aspiração de mecônio. A causa do óbito foi escrita em qualquer linha do atestado de óbito, de acordo com a Classificação Internacional de Doenças, 10a Revisão (P20.0, P21.0 e P24.0). Foi feita uma pesquisa ativa em 27 unidades federativas brasileiras. O teste qui-quadrado de tendência foi aplicado para analisar os índices de mortalidade neonatal associados a asfixia perinatal até o ano do estudo. Resultados: Morreram 10.675 neonatos com peso ≥ 2.500 g sem malformações até 0-6 dias após o nascimento por asfixia perinatal. Os óbitos ocorreram nas primeiras 24 horas após o nascimento em 71% dos neonatos. A síndrome de aspiração de mecônio foi relatada em 4.076 (38%) dos óbitos. O índice de mortalidade neonatal precoce relacionada à asfixia caiu de 0,81 em 2005 para 0,65 por 1.000 nascidos vivos em 2010 no Brasil (p < 0,001); o índice de mortalidade neonatal precoce relacionada a síndrome de aspiração de mecônio permaneceu entre 0,20-0,29 por 1.000 nascidos vivos durante o período do estudo. Conclusões: Apesar da redução nas taxas no Brasil de 2005 a 2010, as taxas de mortalidade neonatal precoce associadas à asfixia perinatal em neonatos no melhor espectro de peso ao nascer e sem malformações congênitas ainda são altas e a síndrome de aspiração de mecônio desempenha um importante papel.Fundacao Sociedade Brasileira de PediatriaUniv Fed Sao Paulo, UNIFESP, Escola Paulista Med, Dept Pediat, Sao Paulo, SP, BrazilUniv Fed Bahia UFBA, Dept Pediat, Salvador, BA, BrazilUniv Fed Rio Grande do Norte UFRN, Dept Pediat, Natal, RN, BrazilUniv Fed Minas Gerais, Dept Pediat, Belo Horizonte, MG, BrazilUniv Fed Sao Paulo, UNIFESP, Escola Paulista Med, Dept Pediat, Sao Paulo, SP, BrazilWeb of Scienc

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting

IntroductionPremature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births.MethodsThis is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0–27 days). Survival functions were calculated using the Kaplan–Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs).ResultsThe neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89–4.65), independent of sex, 1-min Apgar score, and five maternal factors.DiscussionThe risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil

Mortalidade Neonatal Associada À Mortalidade Neonatal Associada À Série Histórica De 2004 A 2013

Objective:To analyze the temporal evolution of the neonatal deaths rate associated with perinatal asphyxia from 2004 to 2013 according to geographical distribution, gestational age (GA) and demographic variables in the State of São Paulo (SP State). Method: Populationbased study including deaths with perinatal asphyxia without congenital anomalies occurred during the first 27 days of life in São Paulo city, in the Metropolitan Area (Capital excluded) and in the countryside of the SP State from 2004 to 2013. Perinatal asphyxia was considered if intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome were written in any line of the original Death Certificate (DC). Data was collected from SEADE Foundation after the linkage of the DC with its respective Birth Certificate based on the deterministic linkage process. The statistics analysis was assessed through Poisson regression model, Kaplan Meier curves, chi-squared test for trend and multivariate Cox regression. Results: From 2004 to 2013, 6,648 deaths resulted from perinatal asphyxia in SSP: 27% in São Paulo city; 21% in the Metropolitan Area (Capital excluded) and 52% in the countryside. The rates of neonatal death with asphyxia in 1,000 live births were 1.16 in 2004 to 0.97 in 2013 in São Paulo city (reduction of 17%; p=0.082); from 1.45 to 0.83 in the Metropolitan Area (reduction of 43%; p<0.001) and from 1.48 to 0.98 ( reduction of 34% ; p<0.001) in the country side. In neonates with 22 to 27 weeks, the reduction rate was higher in the Metropolitan Area than in São Paulo city (p=0.035) and also in neonates from 32 to 36 weeks in the Metropolitan Area (p=0.013) and in the countryside (p=0.003) compared to São Paulo city, with the same reduction rate among the 3 regions for 28-31 weeks and for 37-41 weeks. The median life time until death was 24 hours: higher in São Paulo city (36 hours), followed from the countryside (23 hours) and Metropolitan Area (21 hours). The extreme premature infants had the lowest median time of life (13 hours) and the highest was among the 28-31 weeks (41 hours). Births were more frequent in their hometown, with the reduction of births in SUS hospitals at the Metropolitan Area (p=0.034) and in the countryside (p=0.019), and deaths were more frequent at the same hospital of birth. Teenager mothers were less frequent (p=0.039), with higher rates of primiparous mothers (p<0.001) and cesarean deliveries (p=0.019) and with death reduction among 37-41 weeks (p<0.001) along the ten years. Based on multivariate analysis, adjusting the death year, there was an association of life time to death with: region and birth place, mother’s age, number of prenatal consultations, type of delivery, GA, 1st minute Apgar score, race/colour and sex. Conclusion: Neonatal deaths with perinatal asphyxia reduced significantly during 2004 to 2013, mainly among 32-36 weeks in the Metropolitan Area and in the countryside, most probably due to medical interventions and public policies directed to the pregnant mother and the newborns, which had a great impact in those regions in the State of São Paulo.Objetivo: Analisar a evolução temporal das taxas de óbitos neonatais associados à asfixia perinatal no período de 2004 a 2013 de acordo com a distribuição geográfica, a idade gestacional (IG) e as variáveis demográficas no Estado de São Paulo (ESP). Método:Estudo populacional dos óbitos com asfixia perinatal, sem anomalia congênita, ocorridos até 27 dias de vida na Capital, Área Metropolitana (exceto município de São Paulo) e Interior do ESP de 2004 a 2013. Asfixia perinatal foi definida como presença de hipóxia intraútero, asfixia ao nascer ou aspiração neonatal de mecônio em qualquer linha da Declaração de Óbito (DO) original. O banco de dados foi fornecido pela Fundação SEADE após o pareamento da DO com sua respectiva Declaração de Nascido Vivo com base na técnica de vinculação determinística. A análise estatística incluiu modelo de regressão de Poisson, curvas de Kaplan Meier, teste qui-quadrado de tendência lineare regressão multivariada de Cox. Resultados: De 2004 a 2013 ocorreram 6.648 mortes neonatais com asfixia perinatal no ESP: 27% na Capital, 21% na Área Metropolitana (exceto município de São Paulo)e 52% no Interior. A taxa por mil nascidos vivos foi de 1,16 em 2004 até 0,97 em 2013 na Capital (redução de 17%; p=0,082); de 1,45 para 0,83 na Área Metropolitana (redução de 43%; p<0,001) e de 1,48 para 0,98 (redução de 34%; p<0,001) no Interior. Em recém-nascidos (RN) de 22-27 semanas, o decréscimo na taxa foi maior na Área Metropolitana do que na Capital (p=0,035) e também em RN de 32-36 semanas da Área Metropolitana (p=0,013) e no Interior (p=0,003) em relação à Capital; com mesmo ritmo de redução entre as três regiões em RN de 28-31 semanas e de 37-41 semanas. O tempo mediano de sobrevida foi de 24 horas: maior na Capital (36 horas), seguido do Interior (23 horas) e da Área Metropolitana (21 horas). O menor tempo mediano de sobrevida aconteceu nos extremos prematuros (13 horas) e o maior entre os de 28-31semanas (41 horas). Quanto às características, a maioria dos partos ocorreu no próprio município de residência materna, com redução dos partos em hospitais SUS na Área Metropolitana (p=0,034) e no Interior (p=0,019) e óbito no mesmo hospital de nascimento. Houve redução de mães jovens (p=0,039), aumento de primigestas (p<0,001) e de partos cesáreos (p=0,019), com decréscimo dos RN 37-41 semanas (p<0,001) ao longo dos dez anos. À análise multivariada, ajustando-se pelo ano, houve associação do tempo de vida ao óbito com: região e local de nascimento, idade da mãe, consultas de pré-natal, tipo de parto, IG, escore de Apgar 1º minuto, raça/cor e sexo. Conclusão: Os óbitos neonatais com asfixia perinatal diminuíram de maneira significativa nos anos de 2004 até 2013, em especial nos RN de 32 a 36 semanas, possivelmente devido às intervenções e políticas públicas dirigidas à gestante e ao RN, com maior impacto na Área Metropolitana (exceto município de São Paulo) e no Interior do Estado de São Paulo.Dados abertos - Sucupira - Teses e dissertações (2017

Tracheal suctioning of meconium at birth for non-vigorous infants: A systematic review and meta-analysis

The International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid (MSAF)

Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil,

Abstract Objective: To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing ≥2500 g in Brazil from 2005 to 2010. Methods: The population study enrolled all live births of infants with birth weight ≥2500 g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases,10th Revision (P20.0, P21.0, and P24.0). An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year. Results: A total of 10,675 infants weighing ≥2500 g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24 h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38%) of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (p < 0.001); the meconium aspiration syndrome-specific early neonatal mortality ratio remained between 0.20 and 0.29 per 1000 live births during the study period. Conclusions: Despite the decreasing rates in Brazil from 2005 to 2010, early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight and without congenital malformations are still high, and meconium aspiration syndrome plays a major role

Family presence during resuscitation in paediatric and neonatal cardiac arrest : a systematic review

Context: Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. Objective: To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. Data sources: Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. Study selection: 3200 titles were retrieved in the initial search; 36 ultimately included for review. Data extraction: Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. Results: The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. Limitations: English language only; lack of randomized control trials; quality of the publications. Conclusions: Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

: This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

: This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed