PERINATAL CARE IN A NORTHEASTERN BRAZILIAN STATE: STRUCTURE, WORK PROCESSES, AND EVALUATION OF THE COMPONENTS OF ESSENTIAL NEWBORN CARE

ABSTRACT Objective: To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. Methods: A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants’ records, were also analyzed. Results: Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. Conclusions: The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.

摘要 研究目的：描述巴西塞尔希培州产科医院中针对孕妇及新生儿的照护结构与流程，包括新生儿核心照护（Essential Newborn Care, ENC）。研究方法：本研究为横断面研究，于2015年6月至2016年4月间，在巴西塞尔希培州所有年分娩量超过500例的产科医院（共11家）开展。研究人员向医院管理者发放了涵盖现有照护结构与工作流程的调查问卷；随后对这些医院的768名代表性产后女性进行访谈，并分析了她们及其新生儿的医疗记录。研究结果：塞尔希培州共设有新生儿重症监护病房（Neonatal Intensive Care Unit, NICU）床位78张、中级护理病房（Intermediate Care Unit, IMCU）床位90张，以满足自然分娩与计划分娩的医疗需求。仅6家产科医院（占比54.5%）开展了孕妇风险分级工作，4家（占比36.3%）制定了高危产妇照护方案。关于新生儿核心照护（ENC）的各项内容，仅41%（n=315）的产妇与新生儿实现了早期皮肤接触，33.1%（n=254）的新生儿在出生后1小时内接受了母乳喂养，18%（n=138）的产妇在分娩过程中全程有陪护陪伴。研究结论：结合巴西相关临床指南来看，该州首府与其他城市间的新生儿重症监护病房床位配置较为合理。但本研究发现，当地对高血压与出血急症照护方案的依从性较低，人性化照护政策、孕妇风险分级及新生儿核心照护实践的覆盖率偏低，尤其是出生后1小时内母乳喂养及分娩全程陪护两项举措的落实情况欠佳。