Índice de Apgar 0 a 3 no 1º e 5º minuto e evolução para óbito infantil: estudo populacional no Estado de São Paulo

Abstract

Objective: To determine the incidence and the infant mortality in newborns with Apgar score 0-3 at both 1 and 5 minutes of life, moreover to identify demographic characteristics associated with infant death. Study Design: cohort study population in the State of Sao Paulo, Brazil collected from the database of Fundacao Seade, consisted of the Certificates of Live Births in 2006 and 2007, and the Certificates of Death from 2006 to 2008, by linking deterministic method. Included were live births without congenital malformations with Apgar score 0-3 at both 1 and 5 minutes of life, confirmed in the original Certificates of Births and/or medical records. Logistic regression was applied to determine the demographic variables present at birth associated with infant death. Results: 1,639 of 1,027,132 live births (1,6/1,000) met study criteria. The infant mortality was 70%. Of 1,075 neonatal deaths, 880 (82%) occurred within 24 hours, of which 477 in the first hour of life. The outcome to infant death was 615 (95%) of newborns with Apgar score 0 or 1 and 532 (54%) with 2 or 3 Apgar score at 5 minutes of life. Of the 25 survivors (median birth weight 3.100g) with Apgar scores of 0 at 1 and 5 minutes of life, half of them had neurological abnormalities during hospitalization. Among the 357 infants with a gestational age of 22-27 weeks and Apgar score 0 or 1 at 5 minutes, the only survivor had neurological abnormalities. In the 235 newborns with birth weight . 2500g and in the 627 premature infants with gestational ages between 22-27 weeks with Apgar score 0-3 at both 1 and 5 minutes who died, 81 (35%) in the first group and 480 (77%) in the second did not show diagnosis of intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome in any line of the Certificate of Death. In the population of newborns with Apgar 0-3 at both 1 and 5 minutes, the independent variables associated with infant death were the Apgar score 0 or 1 at 5 minutes (OR 16.61; 95% CI 11.13 to 24.79), low birth weight (OR 7.52; 5.72 to 9.87), birth in outside the capital (OR 1.74; 1.30 to 2.33) in nonpublic hospital (OR 1.55; 1.18 to 2.04) and at night (OR 1.31; 1.002 to 1.71). Conclusion: This population cohort study showed high infant mortality, predominantly in the first 24 hours after delivery, associated with Apgar score 0 or 1 at 5 minutes of life and low birth weight.

Objetivo: determinar a incidencia e a mortalidade infantil nos recem-nascidos com indice de Apgar de 0 a 3 no 1o e 5o minuto de vida, alem de verificar as caracteristicas demograficas ao nascimento associadas ao obito infantil. Metodo: estudo de coorte populacional no Estado de Sao Paulo realizado com a base de dados unificada da Fundacao Seade constituida pelas Declaracoes de Nascido Vivo, de 2006 e 2007, e pelas Declaracoes de Obito de 2006 a 2008, por meio da vinculacao deterministica. Foram incluidos os nascidos vivos sem malformacoes congenitas com indice de Apgar 0 a 3 no 1o e no 5o minuto de vida, confirmado na Declaracao de Nascido Vivo e/ou no prontuario medico. Regressao logistica foi aplicada para determinar as variaveis demograficas presentes ao nascimento associadas ao obito infantil. Resultados: 1.639 nascidos vivos em 1.027.132 (1,6/1000) foram identificados com o indice de Apgar 0 a 3 no 1o e no 5o minuto, com mortalidade infantil de 70%. Dos 1.075 obitos neonatais, 880 (82%) aconteceram nas primeiras 24 horas, dos quais 477 na primeira hora de vida. Evoluiram para obito infantil, 615 (95%) dos nascidos vivos com Apgar 0 ou 1 e 532 (54%) com Apgar 2 ou 3 no 5o minuto de vida. Dos 25 sobreviventes (mediana de peso ao nascer 3100g) com Apgar 0 ou 1 no 1o e no 5o minuto de vida, metade deles apresentou alteracoes neurologicas durante a internacao hospitalar. Dentre os 357 nascidos com idade gestacional de 22-27 semanas e Apgar 0 ou 1 no 5o minuto, o unico sobrevivente apresentou alteracoes neurologicas. Dos 235 recem-nascidos com peso ao nascer .2500g e 627 prematuros com idade gestacional entre 22-27 semanas com Apgar de 0 a 3 no 1o e 5o minuto que faleceram, em 81 (35%) e 480 (77%), respectivamente, nao havia em qualquer linha da Declaracao de Obito, o diagnostico de hipoxia intrauterina, asfixia ao nascer ou sindrome de aspiracao de meconio. Na populacao de nascidos vivos com Apgar de 0 a 3 no 5o minuto, as variaveis independentes associadas ao obito infantil foram o indice de Apgar 0 ou 1 no 5o minuto (OR 16,61; IC 95% 11,13-24,79), o baixo peso ao nascer (OR 7,52; IC 95% 5,72-9,87), o nascimento em hospital fora da capital Sao Paulo (OR 1,74; IC 95% 1,30-2,33), em hospital nao publico (OR 1,55; IC 95% 1,18-2,04) e durante a noite (OR 1,31; IC 95% 1,002-1,71). Conclusao: a coorte populacional estudada evidencia elevada mortalidade infantil, com predominancia nas primeiras 24 horas apos o parto, associada ao indice de Apgar 0 ou 1 no 5o minuto de vida e ao baixo peso ao nascer.