Pragmatic criteria of the definition of neonatal near miss: a comparative study
Pragmatic criteria of the definition of neonatal near miss: a comparative study
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DOI：
10.11606/s1518-8787.2017051006587
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
Silva, Kátia Silveira da
中科院分区：
文献类型：
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作者：
Kale, Pauline Lorena;Jorge, Maria Helena Prado de Mello;Silva, Kátia Silveira da
目的：本研究的目的是测试新生儿未遂事件的定义的实用标准的有效性，将其扩展到整个婴儿期，并估计在公立妇产医院的围产期护理指标。方法：2011年，在圣保罗，尼泰罗伊和巴西里约热内卢市的六家妇产医院进行了一组活产。我们进行了面谈，检查了产前卡和医疗记录。我们比较了Pileggi等人关于未遂的实用标准（出生体重、胎龄和5' Apgar评分），Pileggi-Castro等人，Souza等人，和Silva et al.我们计算了灵敏度、特异性（金标准：婴儿死亡率）、新生儿死亡率（危及生命的情况）、未遂率、死亡率和每1,000例活产的严重结局。结果：共分析了7,315例新生儿（信息完整性> 99%）。Pileggi-Castro等人定义的灵敏度较高，导致更多的未遂病例，Souza等人给出的值较低，Pileggi等人和de Silva等人给出的值居中。当周期从0-6天到0-27天时，灵敏度增加，当周期从0-364天时，灵敏度降低。特异性高（>= 97%），敏感性高（54%-77%）。一个妇产医院在圣保罗和一个在Niterci，分别提出了最低和最高的婴儿死亡率，近错过，并与危及生命的条件下出生的频率，无论definition.CONCLUSIONS：近错过的定义完全基于务实的标准是有效的，可用于监测的目的。基于围产期文献，Silva等人采用的临界点更合适。定期研究可以应用一个更完整的定义，结合临床，实验室和管理标准，包括先天性异常预测婴儿死亡率。
OBJECTIVE: The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals.METHODS: A cohort of live births from six maternity hospitals in the municipalities of Sao Paulo, Niteroi, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5' Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births.RESULTS: A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0-6 to 0-27 days, and there is a decrease when it goes to 0-364 days. Specificities were high (>= 97%) and above sensitivities (54% to 77%). One maternity hospital in Sao Paulo and one in Niterci presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition.CONCLUSIONS: The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.