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Vol. 58. Núm. 5.
Páginas 464-470 (Mayo 2003)
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Vol. 58. Núm. 5.
Páginas 464-470 (Mayo 2003)
Acceso a texto completo
Morbimortalidad en recién nacidos de muy bajo peso en el control de la calidad de la asistencia perinatal
Morbidity and mortality ofvery-low-birth-weight infants as an indicator of the quality of perinatal care
Visitas
8871
A. Valls i Soler
Autor para correspondencia
enadolf@eresmas.net

Correspondencia: Unidad Neonatal. Departamento de Pediatría. Hospital de Cruces.Universidad del País Vasco. EHU.48903 Barakaldo. Bilbao. España.
, S. Páramo Andrés, C. Centeno Monterubio, S. Ansó Oliván, P. Gortazar Arias, I. López de Heredia, A. Cotero Lavín
Unidad Neonatal. Departamento de Pediatría. Hospital de Cruces.Universidad del País Vasco. Barakaldo. Bilbao. España.
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Información del artículo
Objetivo

Comparar los resultados de una cohorte de recién nacidos de muy bajo peso natal (RNMBP) asistidos en nuestra unidad de 1994 a 2000, con referencia al conjunto de todas las variables incluidas en la base de datos de la Red Vermont- Oxford Network (VON).

Métodos

Se seleccionaron los 417 RNMBP nacidos vivos en el centro en los años 1994–2000 . A las 80 variables de la VON ya incluidas en la base de datos de la unidad de modo prospectivo, se añadieron otras 20, mediante revisión retrospective de las historias clínicas. Se analizaron las tasas de los principales antecedentes, intervenciones y causas de morbilidad, comparando los dos períodos , 1994 - 1997 y 1998 - 2000 , así como con los resultados referenciados por la VON.

Resultados

La comparación entre ambos períodos mostró un aumento de embarazos múltiples y del uso de corticoids prenatales, así como de la aplicación de surfactante precoz y presión positiva continua. La tasa de hemorragia intraventricular descendió de manera significativa, sin que se observaran diferencias en otras tasas analizadas. Al comparer nuestros datos con VON, se observó que la tasa de cesáreas, embarazos múltiples y uso de corticoides prenatales fueron más elevadas. Si bien los resultados fueron similares a los de la VON, se detectó un cierto exceso de mortalidad en < 800 g, coincidente con tasas más elevadas de sepsis tardías.

Conclusión

Las tasas de morbilidad neonatal disminuyeron durante el período estudiado, comparando favorablemente con las de la VON. En su conjunto, los resultados evidencian una notable calidad de la asistencia perinatal prestada. La generalización de esta metodología, permitiría comparaciones entre diferentes Unidades, a nivel regional, nacional o Europeo, en una red de unidades recientemente creada (EuroNeoNet.com).

Palabras clave:
Muy bajo peso natal
Morbimortalidad neonatal
Calidad asistencial
Objective

To compare the clinical outcomes of a cohort of very low birth weight (VLBW) infants who received healthcare in our unit from 1994-2000 with all the variables included in the Vermont-Oxford Network (VON) database.

Methods

A historical cohort of 417 VLBW live infants born in our center from 1994-2000 was evaluated. The 80 variables of the VON already prospectively included in the unit's database were used and a further 20 variables were added through retrospective review of medical records. The rates of perinatal risk factors, interventions, and causes of morbidity were analyzed and the periods 1994-1997 and 1998-2000 were compared. We also compared these rates with those reported by the VON.

Results

Comparison of the results in both periods showed an increase in the percentage of multiple pregnancies and prenatal corticosteroid exposure, as well as in the early use of surfactant and continuous positive pressure. The incidence of intraventricular hemorrhage decreased, but no differences were observed in other outcomes. Our rates of Cesarean sections and multiple births, as well as the use of prenatal steroids, were higher than those of the VON. The outcomes of infants receiving healthcare in our unit were similar to those of the VON but mortality in infants weighing < 800 g was slightly higher, coinciding with higher rates of late sepsis.

Conclusion

Morbidity rates in VLWB infants receiving care in our unit decreased during the period studied and compared favorably with those reported by the VON. Alltogether, our results indicate that the quality of care in our perinatal center is good. General use of this methodology would permit comparison of outcomes and quality of care across regions and nations, as well as across Europe, in a recently established network (EuroNeoNet.com).

Key words:
Very Low Birth Weight
Neonatal morbidity mortality
Quality of care
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