Factores asociados con la interrupción del seguimiento ambulatorio de recién nacidos tras el alta de unidades neonatales

Duarte, Elysangela Dittz; Tavares, Tatiana Silva; Cardoso, Isadora Virgínia Leopoldino; Vieira, Carolina Santiago; Guimarães, Bárbara Radieddine; Bueno, Mariana

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0793 copiar

Factores asociados con la interrupción del seguimiento ambulatorio de recién nacidos tras el alta de unidades neonatales

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivso:

identificar los factores predisponentes y facilitadores, y las necesidades de salud asociadas a la interrupción del seguimiento ambulatorio de recién nacidos tras el alta de unidades de cuidados intensivos neonatais.

Métodos:

estudio transversal, que utilizó el modelo conductual de utilización de servicios de salud. Participaron 358 madres y recién nacidos, que fueron orientados al seguimiento ambulatorio para el alta hospitalaria. Se recogieron los datos de caracterización, de percepción de apoyo social, de depresión posparto y de asiduidad a las consultas, siendo analizados en el software R (3.3.1).

Resultados:

el siguimiento ambulatorio fue interrumpido por el 31,28% de los niños durante el primer año tras el alta. En el análisis de regresión múltiple, la probabilidad de interrumpir el seguimiento fue mayor entre los recién nacidos que utilizaron ventilación mecánica (OR = 1,68; IC 95% 1,04-2,72) y dependían de la tecnología (OR = 3,54; IC 95% 1,32-9,5).

Conclusión:

los factores predisponentes fueron asociados con la interrupción del seguimiento; sin embargo, los factores facilitadores y las necesidades de salud no presentaron una asociación significativa. Los niños que presentaban condiciones de salud más complejas requirieron apoyo adicional para participar en los programas de seguimiento y garantizar la continuidad del cuidado.

Descriptores:
Continuidad de la Atención al Paciente; Atención Ambulatoria; Unidades de Cuidado Intensivo Neonatal; Enfermería Pediátrica; Evaluación de Necesidades

Variables		Discontinued		Odds Ratio	p value
Variables		n^* * the value of n changes according with the total number of records of the variable;	%	Odds Ratio	p value
Sex of the child^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	Female	44	26.3	1.00	-
	Male	61	35.5	1.54	0.070
Gestational age at birth^‡ ‡ Events observed at the time of hospital discharge;	< 37 weeks	86	31.0	1.00	-
	≥ 37 weeks	20	32.8	1.08	0.791
Weight at birth^‡ ‡ Events observed at the time of hospital discharge;	< 2500 g ≥ 2500 g	92 14	32.6 25.0	1.00 0.69	- 0.263
Mechanical ventilation^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	No Yes	45 56	26.5 38.1	1.00 1.71	- 0.027
Technology dependence^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	No Yes	101 11	29.7 61.1	1.00 3.72	- 0.008
Age Legal guardian^§ § Events observed in the first outpatient appointment ǂ	< 18 years	9	42.9	1.00	-
	Aged from 18 to 30 years	57	29.1	0.55	0.197
	≥ 30 years	42	31.6	0.62	0.311
Previous children^§ § Events observed in the first outpatient appointment	No	56	29.5	1.00	-
	Yes	52	32.7	1.16	0.516
Mother's educational level^§ § Events observed in the first outpatient appointment ^ǂ ǂ Variable selected for the multivariate model	Illiterate/Some elementary school Elementary school/Some high school High school/Some higher education Higher education	12	38.7	1.00	-
		38 55 5	31.1 30.9 22.7	0.72 0.71 0.47	0.424 0.391 0.224
Declared ethnicity^§ § Events observed in the first outpatient appointment	White Black Mixed Other	19 22 68 1	28.8 29.3 32.5 25.0	1.00 1.03 0.82 1.19	- 0.943 0.568 0.871
Marital status^§ § Events observed in the first outpatient appointment	Without partner With partner	37 73	30.6 31.5	1.00 1.04	- 0.864
Smoker^§ § Events observed in the first outpatient appointment	No Yes	99 10	30.6 32.3	1.00 1.08	- 0.844
Use of drugs^§ § Events observed in the first outpatient appointment	No Yes	107 1	31.1 20.0	1.00 0.55	- 0.599
Edinburgh Scale^§ § Events observed in the first outpatient appointment	< 12 ≥ 12	79 27	30.3 32.9	1.00 1.13	- 0.650

Variables		Discontinued		Odds Ratio	p value
Variables		n^* * the value of n changes according with the total number of records of the variable;	%	Odds Ratio	p value
Social class^§ § Events observed in the first outpatient appointment;	D/E C A/B	18 81 11	28.1 32.5 26.2	1.00 1.23 0.91	- 0.500 0.827
Referral for follow-up after discharge^‡ ‡ Events observed at the time of hospital discharge; ^ǂ ǂ Variable selected for the multivariate model	No Yes	5 107	71.4 30.5	1.00 0.18	- 0.039
Has the Benefício de Prestação Continuada (BPC) [Continuous Provision Benefit]^§ § Events observed in the first outpatient appointment;	No Yes	96 10	30.9 32.3	1.00 1.07	- 0.873
Has another benefit for the child^§ § Events observed in the first outpatient appointment;	No Yes	94 10	30.3 31.2	1.00 1.04	- 0.914
Difficulty to go to the outpatient service^§ § Events observed in the first outpatient appointment; ^ǂ ǂ Variable selected for the multivariate model	No Yes	58 51	27.4 36.7	1.00 1.54	- 0.065
Own car^§ § Events observed in the first outpatient appointment;	No Yes	72 37	30.6 31.9	1.00 1.06	- 0.811
Bus^§ § Events observed in the first outpatient appointment;	No Yes	62 47	29.8 32.9	1.00 1.15	- 0.543
TFD (vehicle provided by the city hall)^§ § Events observed in the first outpatient appointment; ^ǂ ǂ Variable selected for the multivariate model	No Yes	93 16	32.9 23.5	1.00 0.63	- 0.138
Distance^§ § Events observed in the first outpatient appointment;	< 100 km ≥ 100 km and < 200 km ≥ 200 km	91 15 3	31.9 34.1 18.8	1.00 1.10 0.49	- 0.775 0.277
City^§ § Events observed in the first outpatient appointment;	Belo Horizonte Other	40 68	32.5 30.6	1.00 0.92	- 0.717
Overall score - social support scale^§ § Events observed in the first outpatient appointment;	Mean (SD)	106	85(1.6)	1.16	0.844

Variables		Discontinued		Odds Ratio	p value
Variables		n	%	Odds Ratio	p value
Classification of the child's health^ǂ ǂ Variable selected for the multivariate model	Very good	73	33.5	1.00	-
	Good	34	27.4	0.75	0.245
	Average/Very poor	1	11.1	0.25	0.193
Chance of the baby having development problems due to the condition at birth	High/Very high	2	28.6	1.00	-
	Average	12	27.3	0.94	0.943
	Low/Very low	94	31.8	1.16	0.858
Influence of your care for your child's development	High/Very high	101	30.9	1.00	-
	Average	3	33.3	1.12	0.876
	Low/Very low	4	28.6	0.90	0.854
Your child's need for outpatient care^ǂ ǂ Variable selected for the multivariate model	High/Very high	86	34.5	1.00	-
	Average	14	20.0	0.47	0.022
	Low/Very low	9	29.0	0.78	0.542

Variables		Discontinued		Odds Ratio (IC 95%)	p value
Variables		n	%	Odds Ratio (IC 95%)	p value
Mechanical ventilation	No	45	26.50	1.00
Mechanical ventilation	Yes	56	38.10	1.68(1.04-2.72)	0.035
Technology dependence	No	101	29.70	1.00
Technology dependence	Yes	11	61.10	3.54(1.32-9.5)	0.012

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[1] Corresponding author: Elysangela Dittz Duarte. E-mail: elysangeladittz@gmail.com