SIDRIM, Rosabelle Braz. Sepse neonatal em unidade de terapia intensiva : características clínico epidemiológicas, etiologia e fatores de risco. 1999. 156 f. Dissertação (Mestrado em Patologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 1999. / Submitted by denise santos (denise.santos@ufc.br) on 2012-01-02T12:39:22Z
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Previous issue date: 1999 / OBJECTIVE: Neonatal sepsis is currently the most frequent infection and an important cause of death among the newborns admitted at NICU. In order to evaluate the extension of this problem in a tertiary care University Hospital of Northeastern Brazil, a retrospective cohort survey was carried out on all inborn and admitted infants at the Assis Chateaubriand NICU from October 1997 to April 1998. METHOD: the survey design was a retrospective cohort carried out on all inborn infants admitted at the Neonatal Intensive Care Unit during seven consecutive months; 422 newborns were enrolled in the study and each one was followed up from birth to discharge from NCIU or death at the NICU. To compare the levels of the risk factors, two groups were formed: one by the all subjects who developed the outcome and another by all those who did not to. Each member of the cohort was investigated for 34 potential predictors variables concerning mothers factors, neonates factors and hospital procedures. In case of presence of sepsis, the variables were measured just up to the outcome. Standard National Nosocomial Infection Surveillance (NNIS-CDC) definitions of sepsis were used. Chi Square and Fischer’s exact tests were applied for comparison of frequencies; relative risk (RR) with their respective confidence interval of 95% (CI95%) was calculated. Subsequently, a multivariate analysis was done using logistic regression of most significant factors (OR). The level of statistical significance considered was p=0,05. RESULTS: The cohort sepsis incidence was 40,4 for each hundred of newborn admitted at NICU. The bacterias more prevalent of the confirmed cases were the gram-negative bacilli. Most sepsis episodes appeared in the first six days of life (67%). The time of NICU hospitalization of the sick newborn was 4,3 times longer compared to that non-sick newborn. Five factors were selected as independent predictors for neonatal sepsis: central venous catheter (OR=8,7, CI95%=2,31 to 32,69, p=0,001), birth weight of 1000-1499g (OR=4,8, CI95%=2,39 to 9,97, p=0,000), blood transfusions (OR=3,6, CI95%=1,81 to 7,45, p=0,003), singular gestation (OR=2,3, CI95%=1,04 to 5,44, p=0,04) and birth weight of 1500<2500g (OR=2,3, CI95%=1,34 to 4,04, p=0,002). Global mortality reached 25,59% of the cohort. Mortality associated to sepsis was 41,31% with Relative Risk for death = 2,8. CONCLUSION: neonatal sepsis incidence and mortality rates found are higher than in developed countries rates. Birth weight under 2500g, singular gestation, central venous catheter and blood transfusions proved be independent predictors related to neonatal sepsis. This study may contribute for the future strategies for reduction of neonatal sepsis rates and its sequels in our hospital. / A sepse neonatal é atualmente a infecção mais freqüente e importante causa de óbito de RN internados nas UTIN de países desenvolvidos. Para conhecer a dimensão desse problema em um Hospital Universitário de atendimento terciário localizado no Nordeste do Brasil, foi realizado um estudo de coorte retrospectivo de todos as crianças que nasceram e foram admitidas na UTIN no período de outubro de 1997 a abril de 1998. Uma coorte de 422 pares de recém-nascidos e suas respectivas mães foi formada; os RN foram seguidos do nascimento à alta ou óbito na UTIN ou até a idade de 28 dias enquanto internados na UTIN. Ao todo, cerca de 34 variáveis maternas, do neonato e procedimentos hospitalares foram pesquisadas em cada membro da coorte. Os testes estatísticos utilizados foram: Teste do Qui-quadrado e o Teste exato de FISCHER, cálculo do risco relativo com os respectivos intervalos de confiança. Em seguida procedeu-se a análise multivariada com transformação para logística dos fatores mais significativos (p<0,05). Ao final, cinco fatores foram selecionados como preditores independentes da sepse neonatal: cateterização venosa central (OR=8,7, IC95%=2,3 a 32,6), faixa ponderal 1000 a 1499g (OR=4,8, IC95%=2,3 a 9,9), transfusão de hemoderivados (OR=3,6, IC95%=1,8 a 7,4), gravidez única (OR=2,3, IC95%=1,0 a 5,4) e faixa ponderal 1500 a 2499g (OR=2,3, IC95%=1,3 a 4,0). A incidência de sepse na coorte foi de 40,4 para cada 100 RN admitidos (167/413). As bactérias mais prevalentes dos casos confirmados foram os bacilos gram-negativos; 67% dos episódios surgiram nos seis primeiros dias de vida. A internação dos RN com sepse foi 4,3 vezes superior a internação dos RN não acometidos. A mortalidade global na UTIN foi de 25,59 para cada 100 RN admitidos, enquanto a letalidade pelo desfecho foi de 41,31%, com risco relativo de morte por sepse de 2,8. Este estudo poderá ser útil para futuras estratégias com vistas a diminuir a morbimortalidade por sepse neonatal.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.repositorio.ufc.br:riufc/1890 |
| Date | January 1999 |
| Creators | Sidrim, Rosabelle Braz |
| Contributors | Rodrigues, Jorge Luiz Nobre |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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