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Identification of Risk Factors in Infants Participating in a Follow-Up Program

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Identification of Risk Factors in Infants Participating in a Follow-Up Program Rev. CEFAC. 2018 Maio-Jun; 20(3):333-341 doi: 10.1590/1982-021620182038817 Original articles Identification of risk factors in infants participating in a Follow-up program Cibelle Kayenne Martins Roberto Formiga(1) Laryssa Pereira da Silva(1) Maria Beatriz Martins Linhares(2) (1) Universidade Estadual de Goiás, ABSTRACT Goiânia, Goiás, Brasil. (2)’Faculdade de Medicina de Ribeirão Purpose: to identify the main health risk factors of infants participating in a follow-up Preto, Universidade de São Paulo, program. Ribeirão Preto, São Paulo, Brasil. Methods: a longitudinal prospective study conducted with 540 high-risk infants Conflict of interests: Nonexistent observed in the follow-up clinic of the Hospital Materno Infantil in Goiânia in the State of Goiás, Brazil. All biological data of the infants from birth, prenatal, and postnatal periods were collected through assessment sessions with their mothers and medical chart reviews. Data were analyzed through binary logistic regression to identify the highest-risk variables for the infants’ health. Results: in a predictive analysis, the findings showed that neonatal risk was statisti- cally associated with a lower Apgar score at the fifth minute of life, male infants, and longer hospital stay. Infants with increased neonatal risk were more likely to show alte- rations identified in cranial ultrasound examinations. Moreover, the longer hospital stay was related to mixed breastfeeding after discharge. Conclusion: the main risk factors for the health of high-risk infants in the follow-up program were: low Apgar score at the fifth minute; male sex; longer hospital stay; alterations detected in transfontanellar ultrasound; and mixed feeding after discharge. Keywords: Risk Groups; Newborn; Child Health Services Received on: May 29, 2017 Accepted on: April 16, 2018 Mailing address: Profa. Cibelle Kayenne M. R. Formiga Universidade Estadual de Goiás, Campus ESEFFEGO Avenida Anhanguera, nº 3228 - Setor Vila Nova CEP: 74.643.010 - Goiânia, Goias, Brasil E-mail: [email protected] 8817 Formiga CKMR, Silva LP, Linhares MBM Risk factors in infants 334 | Formiga CKMR, Silva LP, Linhares MBM INTRODUCTION longitudinal follow-up, made up of multidisciplinary Neonates (NB) at risk are defined as those who are teams that follow the baby at risk, helping to identify 2,11 exposed to situations with a higher risk of unfavorable and prevent diseases during primary care , and progress, and who are more likely to have higher contributes to define actions to minimize delays and/or 2 mortality and morbidity than average1. sequelae in a differentiated and proactive manner . The Ministry of Health considers that at-risk children The integration of the team in this program provides have at least one of the following criteria: low birth an integral care to the infants and their respective weight (<2500g); less than 37 weeks of gestational age families, and consists of a pediatrician, a neonatol- (GA); severe asphyxia (Apgar <7 at the fifth minute of ogist, a neurologist, a physiotherapist, a psychologist, life); hospitalization or complications in the maternity a speech therapist, a nutritionist, an occupational ward; adolescent mother (<18 years); mother with low therapist, and a social worker. Each professional has level of education (<8 years of education); residence in a defined role within the program, and the exchange a risky area; and/or a history of child death (<5 years) of information is necessary for an adequate approach in the family. Among these, low birth weight (LBW) and to the children and their families2. The present study is prematurity1 are highlighted. warranted by the importance of the theme for profes- Risk factors include the association of environ- sionals and researchers who deal with child devel- mental (extrinsic) and biological (intrinsic) mother opment, especially physiotherapists and speech and child factors, which may often be associated, therapists who aid these children during the hospital leading to a cumulative risk effect2. As for maternal/ stay and follow-up after discharge. fetal complications, the presence of only one isolated The objective of the study is to identify the main maternal complication is rare, and the more factors biological and socioeconomic risk factors associated present, the stronger the risk to the baby’s growth and with the occurrence of prematurity and low birth weight development3. in infants attending a follow-up program in the city of Several studies show changes in the profile of NB Goiânia, state of Goiás, Brazil. at risk, including a higher prevalence of female gender, single mothers with less than 20 years of age, and low METHODS socioeconomic status4. In the literature, a relationship is found between maternal risk factors associated with This study was planned according to the Guidelines LBW and premature birth, including lifestyle, socioeco- and Regulatory Norms of Research, and was approved nomic factors, and clinical conditions. Most mothers by the Human and Animal Research Ethics Committee are between 20 and 29 years of age, have hyper- (CEPHA) of the General Hospital of Goiânia (HGG), tension, urinary tract infection, monthly income below Protocol CEPHA-HGG No. 73/2004. The mothers who two minimum wages, pregnancy stress, and lack of or agreed to participate signed the informed consent form. inadequate prenatal care4. This is a prospective, longitudinal study, conducted With scientific advances and improved health with 540 at-risk infants observed by the team of the care in recent decades there has been a reduction in follow-up program at the Mother and Child Hospital neonatal mortality, but children worldwide continue to (HMI) in the city of Goiânia, state of Goiás. HMI is die every year despite the availability of evidence-based maintained by the Government of the State of Goiás solutions5. (GO), through the Unified Health System (SUS); and is The main causes of neonatal deaths are avoidable, characterized as an institution of tertiary level, because related to gestation, delivery, and neonatal care6. Risk it provides care in neonatal, pediatric, and maternal factors are avoidable when appropriate health services Intensive Care Units (ICU). intervention takes place, evidencing the need for The mothers’ and infants’ epidemiological and care7,8. Many of these factors that should be identified socioeconomic profiles were obtained by means early are not recognized, indicating that there is still a of the Guideline for Characterization of Biological failure in maternal identification and clarification in a Data, Socioeconomic Questionnaire, and Economic timely manner in the prenatal period8,9. Classification Criteria of the Brazilian Association of The follow-up was classified as the best tool for Research Companies (ABEP). The neonatal clinical the monitoring and evaluation of the development of risk of infants was assessed using three indicators: the high-risk newborns10. The program is a systematized Neonatal Medical Index (NMI); the Clinical Risk Index Rev. CEFAC. 2018 Maio-Jun; 20(3):333-341 Risk factors in infants | 335 for Babies I (CRIB I); and the Clinical Risk Index for altered) the predictors were: NMI score; gestational Babies II (CRIB II). age; birth weight; and fifth-minute Apgar score. For the All of the instruments for data collection were predicted variable feeding after discharge (exclusive applied by a physical therapy team that was trained and non-exclusive breastfeeding) the predictors were: and managed by the first author. The mothers were days of hospitalization; gestational age; and birth interviewed during the period of infants’ hospitalization weight. A level of statistical significance of p≤0.05 was in the neonatal intermediate care unit (NICU). The data considered. collected were related to gestation, delivery, immediate postpartum period, and socioeconomic and environ- RESULTS mental conditions of the family. In addition, the infor- mation was complemented with a search in hospital A total of 540 neonates and their mothers who records for the adequate fulfillment of neonatal clinical participated in the follow-up was selected. The mean risk indicators (NMI, CRIB I, and CRIB II). birth weight was 1,888.8g (± 1,753.12), the mean birth length was 43.9cm (± 4.23), and the gestational age was 33.4 weeks (233.92 days ± 175, 5). The sample Data Analysis consisted of 92.40% preterm infants, 7.60% term The collected data were tabulated and analyzed infants. The mean fifth-minute Apgar was 8 (± 1.39). through the Statistical Package for Social Sciences The mean time of hospitalization was 25 days (± (SPSS), version 23.0. Initially, a descriptive analysis of 21.25). The mean post-discharge weight was 1,963.6g the main characteristics of the sample was performed. (± 390.71), and exclusive breastfeeding was the most Then, a Spearman correlation analysis was performed frequent (70%). between the biological and socioeconomic variables. The most frequent complications in neonates The variables that presented statistically significant were respiratory failure (62.1%), jaundice (52.3%), differences were included in the Binary Logistic neonatal infection (49.3%), and transient tachypnea Regression analysis model. The regression models of the newborn (20.5%). Less frequent complications generated in the study will be described below. For the were intracranial hemorrhage, apnea, anoxia, anemia, dependent variable, neonatal risk according to the NMI hypoglycemia, gastroesophageal reflux, convulsion, (low or high neonatal
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