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Doctoral Thesis
DOI
https://doi.org/10.11606/T.6.2020.tde-27032020-105457
Document
Author
Full name
Elisa Maria da Silva Brito
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2001
Supervisor
Committee
Tanaka, Ana Cristina D'Andretta (President)
Latorre, Maria do Rosário Dias de Oliveira
Novaes, Hillegonda Maria Dutilh
Silva, Gulnar Azevedo e
Wunsch Filho, Victor
Title in Portuguese
Estudo de caso controle em dois tempos para analisar os principais preditores do coeficiente de mortalidade neonatal precoce intra-hospitalar das maternidades de Sorocaba, 1995
Keywords in Portuguese
Coeficiente de Mortalidade
Saúde Materno-Infantil
Abstract in Portuguese
Trata-se de um estudo de caso-controle em dois tempos, para discernir o efeito independente dos fatores preditores da mortalidade neonatal precoce intra-hospitalar (MNPI) de Sorocaba. No primeiro tempo foi elaborado modelo de regressão logística com dados da Declaração de Nascidos Vivos dos 11.121 recém-nascidos (RN) de 1995 e dos 107 óbitos neonatais precoces, excluídas as mortes por anomalias congênitas. Estavam associados com a mortalidade neonatal precoce intra-hospitalar: Apgar, peso ao nascer, idade gestacional, sexo e nível de instrução. No segundo tempo realizou-se um estudo de caso-controle com 70 casos (óbitos neonatais precoces) e 280 controles (recém-nascidos vivos) com informações dos prontuários. O modelo de regressão logística revelou associação entre Apgar, peso ao nascer, intercorrência no nascimento, intercorrência no trabalho de parto e a mortalidade neonatal precoce intra-hospitalar. Estes resultados revelam a relatividade do valor preditivo do Apgar e do peso ao nascer, reforçado quando RN com Apgar e peso normais e intercorrência no trabalho de parto e no nascimento apresentaram 79,4% de chance de óbito. Entre os RN com idade gestacional normal, 80% (16 de 19 casos) das intercorrências no trabalho de parto e 84% (23 de 25 casos) das ocorridas no momento do nascimento seriam evitáveis. Verificou-se que todos os hospitais, com exceção de um, apresentaram performance (MNPI) condizente com o risco da demanda.
Title in English
Two-stage case control study for analyzing the main predictive factors for early neonatal mortality in maternities in the city of Sorocaba, Säo Paulo, 1995
Keywords in English
Not available
Abstract in English
The present study is a two-stage case-control study to determine the independent effect of predictive factors for early neonatal mortality (ENM) in maternities in the city of Sorocaba, São Paulo. During the first stage, a logistic regression model with 1995 data from the birth certificates of 11,121 newborns (NB) and of 107 early neonatal deaths was constructed. Deaths due to congenital malformations were excluded. The following parameters were associated with early neonatal mortality: Apgar, birth weight, gestational age, sex and level of education. During the second stage a case-control study with 70 cases (early neonatal deaths) and 280 controls (live newborns) based on data from medical records was performed. The logistic regression model showed an association between Apgar, birth weight, abnormal event during birth, abnormal event during labor and early neonatal mortality. The results showed how relative the predictive value of the Apgar and birth weight are, corroborated by the fact that a NB with a normal Apgar and weight and an abnormal event during labor and upon birth presented a 79.4% chance of dying. Among NBs with a normal gestational age, 80% (16 out of 19 cases) of abnormal events during labor and 84% (23 of 25 cases) of those that occurred at birth could have been avoided. The performance (ENM) of all hospitals, with the exception of one, was compatible with the risk of the population assisted.
 
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DR_476_Brito_2001.pdf (3.61 Mbytes)
Publishing Date
2020-03-27
 
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