Dados do Trabalho

Título

Neonatal near-miss of neonates born with congenital hydrocephalus in Brazil: analysis of a decade.

Resumo

Congenital hydrocephalus (CH) is the variety of hydrocephalus present at birth and is related to impairment in the cognitive and motor development of the children affected. In the context of this disease, neonatal near-miss (NNM) is a tool to access the profile of these newborns and evaluate the care offered to them. This study aims to describe and analyze the neonatal near-misses among neonates born with congenital hydrocephalus (ICD-10 Q03) in Brazil from 2011 to 2020. Data from the Brazil Live Birth Information System (Sistema de Informações sobre Nascidos Vivos/SINASC) were used. NNM was defined by having one or more of very low weight at birth (<1500g), asphyxia at 5 minutes from birth (APGAR at fifth-minute score ≤7), or less than 32 gestational weeks at birth. A descriptive analysis of the data was made and the trends in both near-miss numbers and their ratio to neonatal mortality were evidenced from 2011 to 2020. This trend included a regression model to describe the behavior of the data along the time. In parallel, independent T-tests were used to compare the NNM-related variables between the group of neonates with CH and the live births in general. From 2011 to 2020, a total of 2550 NNM cases were observed among the 7699 newborns with CH, resulting in a NNM rate of 331 cases per 1000 live births. 2013 was the year with the highest NNM rate with a total of 380 NNM per 1000LB with CH, followed by 2012 (328 per 1000LB) and 2015 (335 per 1000LB). During the period, the NNMR trends presented two different behaviors, with an annual percent change (APC) of +1,84% from 2011 to 2013, and with an APC of -2,18% from 2013 to 2020, resulting in a total reduction of 7,85% in the ten years. Comparing the CH group and the general neonates, the first group presented a higher NNM rate (p < 0,001; 95% CI 279-317). Also, there was a higher NNM to mortality ratio (p < 0,05; 95% CI 0,10-0,62) in the neonates with CH, indicating a better success of care for the CH near-misses than for general near-misses, hence there are more cases of NNM per overall deaths. In conclusion, this study applied the neonatal near-miss concept to analyze the live births with congenital hydrocephalus in Brazil, presenting a change of behavior in trends in the last 7 years. A comparative analysis showed that CH neonates present with more cases of NNM, but at the same time present with a higher rate of NNM to mortality, indicating a recovery of the newborns from the conditions of birth.

Palavras Chave

Congenital hydrocephalus; Neonatal near miss; Neurology