NEONATAL MORBIDITY NEAR MISS IN TERTIARY HOSPITALS IN A CAPITAL OF NORTHEAST BRAZIL

ABSTRACT Objective: To characterize near miss neonatal morbidity in tertiary hospitals in a capital city of Northeast Brazil based on Health Information Systems, and to identify differences regarding indicators of near miss cases, allowing the surveillance of newborns with risk of death. Methods: A cross-sectional study carried out in hospitals with neonatal intensive care unit, whose neonatal near miss cases in 2012 were identified from a deterministic linkage between the Mortality Information System and the Live Birth Information System. The biological variables of children, variables related to maternal characteristics and indicators of near miss were calculated by type of service and hospital. Biological variables of children, variables related to maternal characteristics and near miss indicators were calculated by service type and hospital and then compared by ratio difference test, parametric and non-parametric tests for measures of central tendency. Results: Of 24,254 live births, 2,098 cases of neonatal morbidity near miss were identified, most of them concentrated in the public hospitals (89.9%). The combination of birth weight and gestational age had the largest number of cases in both segments, public (43.5%) and private (46%). Variations in neonatal near miss indicators were observed between hospitals, which suggests assistance problems. Conclusions: The concept of neonatal near miss, its applicability with data from Health Information Systems, and its indicators are a preliminary tool to monitor hospital care for newborns by signaling health services that require in-depth evaluation and investments for quality improvement.摘要 研究目的：依托健康信息系统，对巴西东北部某首府城市三级医院的新生儿近死亡病例（neonatal near miss morbidity）特征进行刻画，并分析近死亡病例相关指标的差异，以实现对存在死亡风险新生儿的监测。 方法：本研究为横断面研究，纳入设有新生儿重症监护室（neonatal intensive care unit, NICU）的医院，通过死亡信息系统与活产信息系统的确定性关联，识别2012年的新生儿近死亡病例。分别按服务类型与医院类别统计新生儿生物学特征、产妇相关特征及近死亡病例指标，并采用比值差检验、参数与非参数集中趋势度量检验进行组间比较。 结果：在24254例活产儿中，共识别出2098例新生儿近死亡病例，其中绝大多数集中于公立医院（占比89.9%）。无论公立医院还是私立医院，出生体重与胎龄的组合均为病例数最多的类别，分别占比43.5%与46.0%。不同医院间的新生儿近死亡病例指标存在差异，提示医疗服务存在相关问题。 结论：新生儿近死亡病例的概念、依托健康信息系统的应用方法及其相关指标，可作为初步监测工具，通过识别需开展深度评估与质量改进投入的医疗服务机构，实现对新生儿医院诊疗质量的监控。