■新生儿结局中产妇发病率的负担可能随着医疗保健提供和工具实施的充分性而变化,以改善监测。拉丁美洲国家缺乏这种信息,严重孕产妇发病率和孕产妇死亡的减少仍然具有挑战性。
■为了根据产妇特征确定新生儿结局,包括拉丁美洲医疗机构中不同程度的产妇发病率。
■这是来自五个拉丁美洲和加勒比国家的八个医疗机构的围产期信息系统(SIP)数据库的二级横截面分析。参与者都是2018年8月至2021年6月分娩的妇女,不包括堕胎病例。多胎妊娠和缺少围产期结局信息。作为主要和次要结果指标,根据产妇/妊娠特征和产妇发病程度,对新生儿濒临死亡和新生儿死亡进行了测量.报告了估计的调整后患病率比(PRadj)及其各自的95%CI。
■总共包括85,863名活产儿,有1,250例新生儿濒临失踪(NNM)病例和695例新生儿死亡。NNM和新生儿死亡率分别为14.6和8.1/1000活产,分别。与NNM或新生儿死亡独立相关的条件是需要新生儿复苏(PRadj16.73,95%CI[13.29-21.05]),单身(PRadj1.45,95%CI[1.32-1.59]),产妇濒临死亡或死亡(PRadj1.64,95%CI[1.14-2.37]),先兆子痫(PRadj3.02,95%CI[1.70-5.35]),子痫/HELPP(PRadj1.50,95%CI[1.16-1.94]),产妇年龄(岁)(PRadj1.01,95%CI[<1.01-1.02]),主要先天性异常(PRadj3.21,95%CI[1.43-7.23]),糖尿病(PRadj1.49,95%CI[1.11-1.98])和心脏病(PRadj1.65,95%CI[1.14-2.37])。
■产妇发病率会导致新生儿结局恶化,尤其是在遭受产妇接近错过或死亡的妇女中。根据SIP/泛美卫生组织数据库,所有这些指标可能有助于拉丁美洲的常规情况监测,目的是改变政策并改善孕产妇和新生儿健康。
The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging.
To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities.
This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported.
In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]).
Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.