Providers' compliance with practice guidelines of prenatal and neonatal care to reduce neonatal mortality: 2004 versus 2012.

Iná Da Silva Dos Santos,Alicia Matijasevich,Aline Coletto,Tiago Neuenfeld Munhoz,Renata Jaccottet Freitas,Fernando Barros,Flávio Sérgio Chiuchetta

doi:10.1590/1980-5497201600040002

Abstract

To evaluate providers' compliance with practice guidelines of prenatal and neonatal care in order to reduce neonatal mortality. Uncontrolled before-and-after study designed to evaluate changes that occurred between 2004 and 2012, after the interventions proposed by the Municipality Committee of Research on Child Deaths, Foetal and Maternal Death (COMAI) on the frequency of the process indicators for perinatal assistance improvement. A total of 254 patients were studied in 2004 and 259 patients in 2012. During the study period, there was an increase of 65% in the use of prenatal corticosteroids among pregnant women in preterm labor with gestational age of ≤ 34 weeks (rate of use of 38.0 and 62.8% in 2004 and 2012, respectively; p < 0.001), 35% of increase in the use of surfactant among newborns with ≤ 34 weeks of gestational age (41.3 and 55.6% in 2004 and 2012, respectively; p = 0.025) and a reduction of 16% in the prevalence of hypothermia (70.8 and 59.4% in 2004 and 2012, respectively; p = 0.009) at the neonatal intensive care unit admission. Prenatal and neonatal care practices improved between 2004 and 2012. At the end of the study period, rates of use of antenatal steroids and surfactant were lower than figures reported internationally. Similarly, the frequency of hypothermia at the neonatal intensive care unit admission was higher than the occurrence observed in developed countries.

Highlights

The fourth objective of the Millennium Development Goals is to reduce mortality of children aged under 5 years by two-thirds by 2015, compared to the levels of 1990
During the study period, there was an increase of 65% in the use of prenatal corticosteroids among pregnant women in preterm labor with gestational age of ≤ 34 weeks, 35% of increase in the use of surfactant among newborns with ≤ 34 weeks of gestational age (41.3 and 55.6% in 2004 and 2012, respectively; p = 0.025) and a reduction of 16% in the prevalence of hypothermia (70.8 and 59.4% in 2004 and 2012, respectively; p = 0.009) at the neonatal intensive care unit admission
An uncontrolled before-and-after study was conducted, which evaluated the change occurred between 2004 and 2012, according to the frequency of the following process indicators[10]: use of prenatal corticosteroids, use of surfactant in premature newborns, presence of a pediatrician in the delivery room, and frequency of hypothermia in newborns on arrival to the intensive care units (ICUs)

Summary

Introduction

The fourth objective of the Millennium Development Goals is to reduce mortality of children aged under 5 years by two-thirds by 2015, compared to the levels of 1990. In Brazil, there has been a marked reduction in mortality in children aged under 5 years in the last three decades, with a reduction of 77% of deaths in this age group, overcoming the fourth goal of the millennium three years before the deadline[1]. The main causes of neonatal deaths are premature birth, birth asphyxia, respiratory problems, and infections[2,3]. The effective resuscitation of the newborn in the delivery room is one of the neonatal care practices that contributed to reduce deaths caused by suffocation[4]. A set of techniques — some as simple as maintaining body temperature of the newborn, and others more complex and requiring appropriate instruments, such as intubation — are part of the measures included in the newborn resuscitation process, which should be initiated in succession and following well-established guidelines[5]

Methods

Results

Discussion

Conclusion