Fatores associados à necessidade de internação em Unidade de Terapia Intensiva Neonatal e fatores de risco para morbidades neonatais: hemorragia perintraventricular, leucomalácia periventricular, retinopatia da prematuridade ou displasia broncopulmonar

Abstract

Newborns admitted to a neonatal intensive care unit may have been exposed to risk factors due to obstetric, fetal, perinatal and neonatal clinical intercurrent and interventions, often leading to death or morbidities such as perintraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity or bronchopulmonary dysplasia. In general, the studies report these factors in isolation, but do not explain the period that most contributes to these unfavorable outcomes. The purpose of this study was to verify the factors associated with the need for hospitalization in the Neonatal Intensive Care Unit, the risk factors for morbidities (perintraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity or bronchopulmonary dysplasia) in newborns, to compare the risk factors for hospitalization in neonatal intensive care unit in 2009 and 2017/2018 and if there was difference between the studied periods. Analytical-descriptive, observational, longitudinal study for neonatal intensive care unit and longitudinal, observational, prospective, population-based for morbidities. Study population: all newborns hospitalized in 2009 in the three Neonatal Intensive Care Units that serve the users of the Unified Health System, in the city of Juiz de Fora (n = 254, or 97.7%). For each case, two newborns were included for the control group (n = 488). The inclusion of participants began on January 1, 2009 and ended on December 31, 2009. For the data for the year 2017, the study sample was composed of Rns who were born in the period from October 1, 2017 to March 28 2018 in the same maternities and neonatal intensive care unit. In this sample, 30 RNs hospitalized in neonatal intensive care unit and 60 in the control group were added. The data were stored in a database of the Statistical Package for Social Science, version 25.0 for IOS. They were collected using the Vermont Oxford Network forms and proper form. To describe the population profile according to the variables under study were made frequency tables of the categorical variables, with the absolute (n) and relative (%) frequency values. The chi-square test or Fisher's exact test was used. If the frequency in the subgroups was ≥ 5 and p-value ≤ 0.10, the variable was included in the regression models. In the analysis of the factors associated with "hospitalization in Neonatal Intensive Care Unit", binomial logistic regression was used; already in the analysis of the risk factors for morbidities was used Poisson regression. Theoretical models of determination were constructed with three blocks of hierarchical variables. The main factor for the hierarchy of these blocks was their order of appearance over time, except for the first one. Significant variables were included in the following models until reaching the final model. The factors associated with neonatal morbidity in the Poisson regression, considering the three all together groups, were fetal distress, hospitalization time greater than 34 days and mechanical ventilation longer than 24 hours. The risk factors for neonatal intensive care unit stay in binary logistic regression were prematurity, male sex, low birth weight, resuscitation in the delivery room, respiratory distress syndrome and small for gestational age. When the analysis was performed for preterm newborns, the risk factors were low birth weight, resuscitation in the delivery room and respiratory distress syndrome. For full-term newborns, the risk factors were SGA, TORCH, multiple gestation, resuscitation in the delivery room, and respiratory distress syndrome. The difference in the relative frequencies of the factors associated with NICU admission (prematurity, low birth weight, very low birth weight, maternal age under 20 years, maternal hypertension, prenatal care with less than 6 visits, and cesarean delivery) were not statistically significant compared to the years 2009 and 2017/2018. Maternal age above 35 years, maternal diabetes, urinary tract infection, prenatal care had a higher occurrence in 2017/2018. Asphyxia had a significantly lower occurrence in the last analyzed period. The results indicate that the factors associated with neonatal intensive care unit hospitalization and the risk factors for morbidities (perintraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity or bronchopulmonary dysplasia) of NB who required hospitalization in neonatal intensive care unit are significantly associated with factors that occurred in all the pre, peri and neonatal periods, since they are present in all the studied groups (biological, maternal / perinatal or neonatal). The analysis reiterates the need for very close cooperation between obstetricians and neonatologists in order to reduce the incidence of morbidities and hospitalization in neonatal intensive care unit. This study also indicates the relevance of monitoring the development of newborns who have admitted to the neonatal intensive care unit over the years. This reinforces the importance of the implementation and maintenance of "Follow up" services.