Fatores associados ao escore de Apgar no 1o minuto e à mortalidade neonatal em Foz do Iguaçu – PR no período de 2012 a 2016
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Data
2018-01-11
Autores
Souza, Suzana
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A mortalidade infantil é o principal indicador de saúde de uma população, e o componente neonatal, além de responder pela maior parte dos óbitos infantis, está sob maior influência da atenção materno-infantil. Foz do Iguaçu diverge da tendência nacional de queda da taxa de mortalidade infantil, mas são desconhecidos os fatores associados à morbimortalidade neonatal no município. Objetivo: Identificar fatores associados à mortalidade neonatal e ao baixo escore de Apgar no 1º minuto no município de Foz do Iguaçu no período de 2012 a 2016. Método: Este trabalho consistiu de dois subprojetos relativos à morbimortalidade neonatal em Foz do Iguaçu no período de 2012 a 2016, ambos utilizando-se de análise de dados secundários do SIM e do SINASC. O primeiro foi um estudo caso-controle que investigou os determinantes da mortalidade neonatal, e o segundo foi uma pesquisa seccional que investigou os determinantes do escore de Apgar no 1º minuto. Foram executados modelos de regressão logística univariada e múltipla. A seleção das variáveis para a regressão logística múltipla baseou-se no modelo conceitual hierárquico; para a análise dos fatores associados a mortalidade neonatal no nível distal foram alocadas as variáveis sociodemográficas maternas (idade, escolaridade, raça, estado civil e gestações prévias), no nível intermediário as variáveis assistenciais (consultas pré-natais, início do pré-natal, tipo de parto, indução do trabalho de parto) e no nível proximal as variáveis biológicas (idade gestacional, anomalia, sexo, peso e escore de Apgar no 1º minuto). Para a análise dos fatores associados ao baixo escore de Apgar no 1º minuto no nível distal foram alocadas as variáveis sociodemográficas maternas (idade, escolaridade, raça, estado civil, filhos tidos vivos, filhos tidos mortos e gestações prévias), no nível intermediário as variáveis assistenciais (consultas pré-natais, início do pré-natal, tipo de parto, indução do trabalho de parto, profissional que assistiu ao parto, cesariana em relação ao parto) e no nível proximal as variáveis biológicas (idade gestacional, anomalia, sexo, posição fetal e peso). Resultados: Anomalia, baixo escore de Apgar no 1º minuto, peso, consultas pré-natais e idade gestacional apresentaram-se associados à mortalidade neonatal. Idade gestacional, anomalia, peso ao nascer, apresentação fetal, trabalho de parto induzido, estado civil e sexo apresentaram-se associados ao escore de Apgar no 1º minuto. Conclusão: As variáveis biológicas apresentaram-se mais fortemente associadas à morbimortalidade neonatal em Foz do Iguaçu. Com base nos resultados do trabalho, sugere-se a realização de estudos que descrevam a epidemiologia dos partos prematuros e seus determinantes no município, bem como investiguem a associação entre as variáveis estatisticamente relacionadas à morbimortalidade neonatal. Na prática, recomenda-se que o município invista em ações de prevenção da prematuridade evitável, com foco na atenção pré-natal.
Infant mortality is the main health indicator of a population, and the neonatal component, in addition to responding for most infant deaths, is closely related to maternal and newborn care. Foz do Iguassu differs from the Brazilian tendency of reducing the infant mortality rate, but the factors associated with neonatal morbidity and mortality in the municipality remains unknown. Objective: To identify factors associated with neonatal mortality and low Apgar score at first minute in Foz do Iguassu between 2012 and 2016. Method: This work consisted of two subprojects related to neonatal morbidity and mortality in Foz do Iguassu in the period of 2012 to 2016, both using secondary data analysis from SIM and SINASC. The first was a case-control study that investigated the determinants of neonatal mortality, and the second was a cross-sectional study that investigated the determinants of the Apgar score at first minute. Univariate and multiple logistic regression models were performed. The selection of variables for multiple logistic regression was based on the hierarchical conceptual model; for the analysis of factors associated with neonatal mortality in the distal level the maternal sociodemographic variables were allocated (age, schooling, race, marital status, previous pregnancies), at the intermediate level the assistance variables (prenatal appointment, early prenatal care, type of birth, induction of birth), in the proximal level the biological variables (gestational age, anomaly, gender, weight birth, Apgar score at first minute). For the analysis of the factors associated with the low Apgar score at first minute in the distal level the maternal sociodemographic variables were allocated (age, schooling, race, marital status, live children, dead children, previous pregnancies) at the intermediate level the assistance variables (prenatal appointment, early prenatal care, type of birth, induction of birth, professional who attended the birth, cesarean in relation to labor birth) in the proximal level the biological variables (gestational age, anomaly, gender, fetal position, weight birth). Results: Anomaly, low Apgar score at first minute, birth weight, prenatal appointments and gestational age were associated with neonatal mortality. Gestational age, anomaly, birth weight, newborn presentation, birth induced, marital status and gender of the newborn were associated with the first minute Apgar score. Conclusion: Biological variables were more strongly associated with neonatal morbidity and mortality in Foz do Iguaçu in the period from 2012 to 2016. Based on ours results, we suggest that new studies describe the epidemiology of preterm births and their determinants in the city, as well as to investigate the association among the variables statistically related to neonatal morbidity and mortality. In practice, it is recommended that the municipality invest in actions to prevent preventable prematurity, with a focus on prenatal care
Infant mortality is the main health indicator of a population, and the neonatal component, in addition to responding for most infant deaths, is closely related to maternal and newborn care. Foz do Iguassu differs from the Brazilian tendency of reducing the infant mortality rate, but the factors associated with neonatal morbidity and mortality in the municipality remains unknown. Objective: To identify factors associated with neonatal mortality and low Apgar score at first minute in Foz do Iguassu between 2012 and 2016. Method: This work consisted of two subprojects related to neonatal morbidity and mortality in Foz do Iguassu in the period of 2012 to 2016, both using secondary data analysis from SIM and SINASC. The first was a case-control study that investigated the determinants of neonatal mortality, and the second was a cross-sectional study that investigated the determinants of the Apgar score at first minute. Univariate and multiple logistic regression models were performed. The selection of variables for multiple logistic regression was based on the hierarchical conceptual model; for the analysis of factors associated with neonatal mortality in the distal level the maternal sociodemographic variables were allocated (age, schooling, race, marital status, previous pregnancies), at the intermediate level the assistance variables (prenatal appointment, early prenatal care, type of birth, induction of birth), in the proximal level the biological variables (gestational age, anomaly, gender, weight birth, Apgar score at first minute). For the analysis of the factors associated with the low Apgar score at first minute in the distal level the maternal sociodemographic variables were allocated (age, schooling, race, marital status, live children, dead children, previous pregnancies) at the intermediate level the assistance variables (prenatal appointment, early prenatal care, type of birth, induction of birth, professional who attended the birth, cesarean in relation to labor birth) in the proximal level the biological variables (gestational age, anomaly, gender, fetal position, weight birth). Results: Anomaly, low Apgar score at first minute, birth weight, prenatal appointments and gestational age were associated with neonatal mortality. Gestational age, anomaly, birth weight, newborn presentation, birth induced, marital status and gender of the newborn were associated with the first minute Apgar score. Conclusion: Biological variables were more strongly associated with neonatal morbidity and mortality in Foz do Iguaçu in the period from 2012 to 2016. Based on ours results, we suggest that new studies describe the epidemiology of preterm births and their determinants in the city, as well as to investigate the association among the variables statistically related to neonatal morbidity and mortality. In practice, it is recommended that the municipality invest in actions to prevent preventable prematurity, with a focus on prenatal care
Abstract
Descrição
Trabalho de Conclusão de Curso apresentado
ao Instituto Latino-Americano de Ciências da
Vida e da Natureza da Universidade Federal da
Integração Latino-Americana, como requisito
parcial à obtenção do título de Bacharel em
Saúde Coletiva.
Orientador: Prof. Dr. Fernando Kenji Nampo
Palavras-chave
Saúde materno-infantil, Índice de Apgar, Mortalidade infantil, Mortalidade neonatal, Fatores epidemiológicos
Citação
SOUZA, Suzana. Fatores associados ao escore de Apgar no 1o minuto e à mortalidade
neonatal em Foz do Iguaçu – PR no período de 2012 a 2016. 2017. 60 p. Trabalho de
Conclusão de Curso (Graduação em Saúde Coletiva). Universidade Federal da Integração
Latino-Americana, Foz do Iguaçu