Brazilian University Hospital Research Articles

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates.

To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Efficiency in university hospitals: A genetic optimized semi-parametric production function

This paper investigates the social-welfare efficiency drivers of public university hospitals in Brazil by focusing on how the surrounding social welfare conditions may affect their performance. A novel Genetic Envelopment Analysis (GEA) approach is developed here to this end. Subsequently, LASSO regression is applied to filter the impact of social-welfare related variables –on efficiency scores. Results indicate that beds, number of employees and number of doctors are the influential factors in determining the efficiency level, while the operating scales are not relevant to the productivity level. We further find that there is a degree of difference related to the efficiency level among the hospitals in the sample. Finally, our results show that GEA estimates present higher discrimination and dispersion compared to DEA, SFA and TOPSIS, also GEA provides the most reliable and accurate results. In the second stage analysis, we find that female population ratio and high school ratio significantly affect the efficiency level in a negative manner, while the urban population ratio has a significant and positive impact. Based on these results, we provide important policy implications.

Maternal Near Miss in Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity. This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM). The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5-96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2-10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0-50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6-1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7-7.9 and p = 0.0009; OR: 17.68; 95%CI: 2-153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3-440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2-26.3]). Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.

Percepções de acadêmicos e equipe de enfermagem sobre o projeto de extensão: “Caminhando pelo hospital”

ABSTRACT Objective: To know the perception of academics and nursing staff about the extension project “Walking through the hospital”. Method: Qualitative study conducted in a Brazilian university hospital from November/2019 to April/2022 with nursing students and professionals participating in a university extension project. Data were collected using instruments on the Google Forms® platform and submitted to Content Thematic Analysis. The project was approved by the Ethics Committee. Results: Fifteen academics, four nurses and six nursing technicians participated in the study. Four categories emerged from the analysis: “Knowing the hospital environment/dynamics”, “Articulation between theory and practice”,“Bond between academics and health care professionals” and “Work process in the unit”. Final considerations: The findings highlight the importance of university extension in providing knowledge and experienceof hospital clinical practice, which can contribute to strengthening teaching and academic training in nursing.

Sociodemographic profile, diagnoses and nursing care in post-COVID-19 patients in a Brazilian university hospital

RESUMO Objetivos: analisar o perfil sociodemográfico, diagnósticos e cuidados de enfermagem de pacientes pós-COVID-19 internados em um hospital universitário do sul do Brasil. Métodos: estudo de coorte retrospectivo. A amostra foi constituída de 1.467 prontuários, no período de janeiro de 2020 a janeiro de 2021. Resultados: dos prontuários analisados, os perfis, respectivamente, mais prevalentes incluíram: pessoas do sexo masculino (52,9%); da cor branca (81,1%); com Diagnóstico de Enfermagem de síndrome do equilíbrio fisiológico prejudicado* (77,3%); cuidados de enfermagem implementar medidas de precauções por aerossóis (94,5%); implementar medidas de precaução por gotículas (93,4%); verificar sinais vitais (91,9%); aplicar desinfetante padrão em equipamentos e superfícies (89,6%). Conclusões: a análise do perfil sociodemográfico, diagnósticos e cuidados de enfermagem dos pacientes deste estudo poderá contribuir à implementação do Processo de Enfermagem no contexto pandêmico do coronavírus.

Sociodemographic profile, diagnoses and nursing care in post-COVID-19 patients in a Brazilian university hospital.

to analyze the sociodemographic profile, diagnoses and nursing care of post-COVID-19 patients admitted to a university hospital in southern Brazil. a retrospective cohort study. The sample consisted of 1,467 medical records, from January 2020 to January 2021. from the analyzed medical records, the most prevalent profiles, respectively, included: males (52.9%); white (81.1%); with Impaired Physiological Balance Syndrome* Nursing Diagnosis (77.3%); nursing care implementing aerosol precautions (94.5%); implementing droplet precautions (93.4%); checking vital signs (91.9%); applying standard disinfectant to equipment and surfaces (89.6%). the analysis of the sociodemographic profile, diagnoses and nursing care of patients in this study may contribute to implementing the Nursing Process in the coronavirus pandemic context.

Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data

IntroductionOptimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic. MethodsIn this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID-19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. ResultsThe study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores. Discussion and conclusionsThe authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.

Appraising epidemiology data and antimicrobial resistance of urinary tract infections in critically ill adult patients: a 7-year retrospective study in a referral Brazilian hospital.

Urinary tract infections (UTI) are highly preventable and have significant clinical and financial impact on the patient and the health care system. To investigate UTIs in critically ill adult patients and the relationship of antimicrobial consumption and multidrug-resistant isolate. A cohort study performed in a Brazilian tertiary-care university hospital in the city of Uberlandia (MG), located at the Federal University of Uberlandia, southeast region of the country. We analyzed a cohort of 363 patients with first episode of UTIs from the adult intensive care unit (ICU), from January 2012 to December 2018. The daily doses of antimicrobial administered were calculated. The incidence rate of UTI was 7.2/1000 patient days, with 3.5/1000 patient-days of bacteriuria, and 2.1/1000 patient-days of candiduria. Of 373 microorganisms identified, 69 (18.4%) were Gram-positive cocci, 190 (50.9%) Gram-negative bacilli, and 114 yeasts (30.7%). Escherichia coli and Candida spp. were the most common. Patients with candiduria had higher comorbidity score (Charlson Comorbidity Index ≥ 3), longer length of stay (P = 0.0066), higher mortality (P = < 0.0001) severe sepsis, septic shock, and were immunocompromised when compared with patients with bacteriuria. We observed correlation between antibiotics consumption and multidrug-resistant (MDR) microorganisms. The UTIs incidence was high and was mainly caused by Gram-negative bacteria that were resistant to common antibiotics. We observed increase in the consumption of broad-spectrum antibiotics in ICU correlating with MDR microorganisms. In general, ICU-acquired candiduria may be associated with critical illness and poor prognosis.

Espectroscopia no infravermelho próximo (NIRS) em unidade de terapia intensiva neonatal: experiência de um hospital universitário brasileiro

Near-infrared spectroscopy (NIRS) is a non-invasive method to assess regional brain and/or renal oxygenation, and an important tool for a better clinical management. The aim of this study was to describe clinical cases of newborns admitted to the Neonatal Intensive Care Unit of a Brazilian university hospital who were monitored with NIRS, and to evaluate the applicability of NIRS demonstrating its use as a continuous monitoring method for newborns at high risk for brain injury. This study was part of the Conclusion Work of Medical Residency in Neonatology in Neonatology. Case 1: Persistent ductus arteriosus-NIRS guided indication for drug treatment. Case 2: Septic shock-NIRS was helpful identifying the need of inotropes. Case 3: Anemia of prematurity-NIRS showed an increase of cerebral oxygenation after red blood cells transfusions. Case 4: Hypoxic-ischemic encephalopathy-NIRS identified sign of poor neurological prognostic. NIRS is a continuous cerebral and renal perfusion monitoring method that has easy and good applicability and no complications. The cases reflect the importance and potential of NIRS in clinical practice and in helping diagnose for newborns, as well as enabling prognostic assessment. NIRS proved to be a method of good applicability, without short-term complications. Observing brain oxygenation values can help to avoid conditions associated with the development of neurological sequelae.

Assessment of Eating Habits and Preconception and Gestational Nutritional Status of Women Who Attended the Prenatal Service of a Brazilian University Hospital

Introduction Adequate nutritional status should be seen as a fundamental point of prenatal care to avoid obstetric complications and promote the baby’s health. This study aimed to compare prenatal body mass index (BMI) and BMI for gestational age (GA) and lifestyle habits of high-risk and low-risk pregnant women at a Brazilian University Hospital. Methodology This is a descriptive cross-sectional study with a quantitative approach using a questionnaire. Statistical analyzes were performed using Statistical Package for Social Sciences (SPSS) version 26.0. The significance level adopted was 5% (p&lt;0.05). Results The present research involved 78 pregnant women, 51.3% of whom were low-risk. Most pregnant women (73.1%) did not practice physical activity and, among those who did, most reported practicing between 2 and 3-hours per week of light activity. In addition, most (57.7%) interviewees reported sleeping more than 7-hours a night. The pre-pregnancy BMI was adequate in only 34.6% of the patients, while 59% were overweight (overweight or obese); at the time of the interview, BMI for gestational age was normal in only 28.2%, and 66.7% had a BMI reflecting overweight. Consumption of sweets during the week showed significant variation: the high-risk group had a higher percentage of patients who did not consume sweets during the week (44.7%) compared to the low-risk group (20%). Furthermore, while in the high-risk group, only 7.9% consumed sweets 5 to 7 times a week, 30% of the low-risk group consumed sweets 5 to 7 times a week. Conclusion The evaluated pregnant women have a prevalence of excess weight of 66.6%, higher than that of Brazilian women (53.9%). Comparison between preconception BMI and BMI for GA showed a tendency to persist in the pre-pregnancy classification; when there was a change in the distribution of the BMI classification, this occurred with a reduction in the number of underweight, eutrophic, and overweight women and an increase in the percentage of pregnant women with obesity. The diet, in general, was sufficient in terms of micronutrients and fiber, but with high consumption of sweets by low-risk pregnant women. In addition, the proportion of sedentary pregnant women is extremely high. Our study shows the importance of promoting healthy habits during prenatal care to improve pregnant women’s nutritional diagnosis

Dysarthria in hereditary spastic paraplegia type 4

ObjectiveTo describe the speech pattern of patients with hereditary Spastic Paraplegia type 4 (SPG4) and correlated it with their clinical data. MethodsCross-sectional study was carried out in two university hospitals in Brazil. Two groups participated in the study: the case group (n = 28) with a confirmed genetic diagnosis for SPG4 and a control group (n = 17) matched for sex and age. The speech assessment of both groups included: speech task recording, acoustic analysis, and auditory-perceptual analysis. In addition, disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). ResultsIn the auditory-perceptual analysis, 53.5% (n = 15) of individuals with SPG4 were dysarthric, with mild to moderate changes in the subsystems of phonation and articulation. On acoustic analysis, SPG4 subjects’ performances were worse in measurements related to breathing (maximum phonation time) and articulation (speech rate, articulation rate). The articulation variables (speech rate, articulation rate) are related to the age of onset of the first motor symptom. ConclusionDysarthria in SPG4 is frequent and mild, and it did not evolve in conjunction with more advanced motor diseases. This data suggest that diagnosed patients should be screened and referred for speech therapy evaluation and those pathophysiological mechanisms of speech involvement may differ from the length-dependent degeneration of the corticospinal tract.

EPH111 Causes of Medication Administration Errors in a University Hospital in Brazil

EPH111 Causes of Medication Administration Errors in a University Hospital in Brazil

Impact of the COVID-19 pandemic on the routine of an infusion center of immunobiologicals from a Brazilian University Hospital.

Impact of the COVID-19 pandemic on the routine of an infusion center of immunobiologicals from a Brazilian University Hospital.

Monitoring daily symptoms and (self-reported) exacerbations in patients with bronchiectasis: a prospective study.

Exacerbations are pivotal events in the natural history of patients with non-cystic fibrosis bronchiectasis (NCFB), since they have a negative impact on the functional evolution of these individuals. The daily symptoms of patients with NCFB show great variability, which negatively affects their self-perception of symptoms and exacerbations. The aim of this study was to identify daily symptoms in patients with NCFB, and to investigate whether there is a correlation between the frequency of self-reported exacerbations and events defined according to the criteria established in the literature to define exacerbation in bronchiectasis. This observational and prospective study was carried out in outpatient clinics of a Brazilian public university hospital. Over 24 weeks, patients completed a diary in which daily symptoms, self-reported exacerbations, and demands for medical care for respiratory symptoms were recorded. The instrument used (diary and symptom scores ranging from 0 to 12) were developed by the researchers. The participants also answered questionnaires mMRC, Leicester's, and St. George's Respiratory (SGRQ). Twenty-eight patients returned the diary, their mean age was 54 years, and 50% out of them were classified as mild by the FACED score. Cough (64%) and expectoration (62%) were the most frequent symptoms. Correlations were found between the stability score and the mMRC (r=0.4727, p=0.011) and SGRQ (r=0.6748, p<0.0001) questionnaires. The number of self-perceived exacerbations (24) was significantly lower than exacerbations using the exacerbation consensus (63) (p<0.01). Additionally, no correlation was found between these two criteria. There was great variability of symptoms among the individuals sampled, and even for the same individual, over time. Patients had low self-perception of exacerbations, which suggests that strategies aimed at improving this self-perception may contribute to the early detection of exacerbations.

Incidence of healthcare-associated Clostridioides difficile infection in a quaternary referral university hospital in Brazil

Clostridioides difficile infection (CDI) is an important cause of diarrhea in hospitals worldwide. The incidence of CDI in Latin America has not yet been standardized. To fill this gap, the present study performed a daily active surveillance, for three months, between April to July of 2021, at a quaternary referral university hospital in Brazil. The incidence density was 9.2 cases per 10,000 patient-days. Cases were associated mostly with ribotypes 014 and 106 (44% and 22%, respectively). Ribotype 027 was not identified. The findings strongly reinforce the need for broad epidemiological studies on the incidence of CDI in Brazilian hospitals to increase the understanding, prevention, and treatment of this infection.

Long-term respiratory outcomes after COVID-19: a Brazilian cohort study.

To investigate the prevalence and risk factors for persistent symptoms up to 12 months after hospital discharge in COVID-19 survivors. This prospective cohort study included patients with COVID-19 discharged from a university hospital in Brazil. Follow-up was performed 2, 6, and 12 months after discharge. Lung function tests and chest computed tomography (CT) were performed 2 months after discharge and were repeated if abnormal. The primary outcomes were the symptoms present, work status, and limitations in daily activities. Eighty-eight patients were included. Dyspnea (54.5%), fatigue (50.0%), myalgia, and muscle weakness (46.6%) were the most common symptoms, which decreased over time. Anxiety was frequent (46.6%) and remained unchanged. One year after discharge, 43.2% of the patients reported limitations in daily activities, and 17.6% had not returned to work. Corticosteroid use was significantly associated with dyspnea and limitations in daily activities. Females had an increased risk of fatigue at the 12-month assessment, with marginal significance after multivariable adjustment. Young age and bronchial wall thickening on admission CT were also risk factors for dyspnea at follow-up. The most common lung function abnormalities were reduced diffusion capacity and small airway disease, which partially improved over time. One year after hospital discharge, more than one-third of patients still had persistent COVID-19-related symptoms, remarkable dyspnea, fatigue, and limitations in daily activities, regardless of acute disease severity. Age, female sex, corticosteroid use during hospitalization, and bronchial thickening on admission CT were associated with an increased risk of sequelae.

Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital

BackgroundMohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. ObjectiveTo study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. MethodsThis was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. ResultsDuring the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. Study limitationsThis is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service. ConclusionThis retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Selection dynamics of HCV genotype 3 resistance-associated substitutions under direct-acting antiviral therapy pressure.

The chronic hepatitis C (CHC) treatment is currently based on the use of direct-acting antivirals (DAAs), and patients infected with hepatitis C virus genotype 3 (GT3) have emerged as a more difficult-to-cure population. The NS5A inhibitor daclatasvir (DCV) and sofosbuvir (SOF), an NS5B viral polymerase inhibitor, are among the drugs that compose more effective and safer treatment regimens. The virus genetic variability is related to resistance-associated substitutions (RASs) that adversely impact DAAs effectiveness. The aims of this study were to analyze the association of NS5A and NS5B RASs and other clinical factors with DAAs regimens effectiveness in patients with GT3 CHC infection. This was a prospective cohort study performed in a Brazilian university hospital. Individuals older than 18 years with GT3 CHC treated with SOF+DCV ± ribavirin (RBV) or SOF+peginterferon (PEG)+RBV were included. Blood samples were collected at baseline and post-treatment. A total of 121 patients were included. Sustained virological response rates were 87.6% for the SOF+DCV ± RBV group and 80.0% for the SOF+PEG+RBV arm. Cirrhosis, prior treatment with interferon/PEG+RBV, and baseline NS5A RAS were associated with higher risk of treatment failure. The NS5A analysis suggested that A30K, Y93H, and RAS at site 62 were related to failure. Interestingly, a likely compensatory effect was shown between A30K and A62T. Emergence of Y93H was always associated with RAS at position 62. The RASs dynamics comprehension is an important tool to indicate more effective treatment for GT3 patients.

Wasting syndrome and associated factors in hospitalized older people

Wasting syndrome (WS) is characterized by clinically important unintentional weight loss >5 % in six to 12 months. This syndrome is responsible for a significant portion of hospitalizations throughout the world and is an important indicator of serious diseases, especially in individuals with 60 years of age or older. The aim of the present study was to investigate WS and associated factors in hospitalized older people. An observational cross-sectional study was developed at a university hospital in Brazil with male and female patients ≥60 years of age. WS was considered in the occurrence of unintentional weight loss of 10 % in 12 months, 7.5 % in six months or >5 % in three months. Data were collected on sociodemographic, clinical, lifestyle, nutritional and biochemical characteristics. This study received approval from the local institutional review board and all participants signed a statement of informed consent. The sample was composed of 178 older people with a mean age of 70.0 ± 8.0 years. The prevalence of WS was 45.5 %. WS was associated with the following clinical variables: conservative CKD (p = 0.007), dysphagia (p = 0.035), dementia (p = 0.017), anorexia (p < 0.001), fatigue (p = 0.001), functional dependence (measured using the Barthel Index) (p = 0.001) and medications that cause malabsorption (p = 0.020); the following nutritional variables: body mass index (p < 0.001), low calf circumference (p < 0.001), low muscle strength (p = 0.001), low muscle mass (p < 0.001) and undernourishment or risk of malnutrition (evaluated using the Mini Nutritional Assessment); and the following biochemical variables: high CRP (p = 0.027), hypoalbuminemia (p = 0.005) and anemia (p < 0.001). The prevalence of WS was high among the hospitalized older people in the present sample and was associated with clinical and biochemical aspects as well as all nutritional variables analyzed. In contrast, lifestyle and sociodemographic characteristics were not associated with wasting syndrome.

Impact of children with complex chronic conditions on costs in a tertiary referral hospital.

ABSTRACTOBJECTIVES To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil.METHODS This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year.RESULTS Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients’ complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95).CONCLUSIONS Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.