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On-line version ISSN 1678-4782
J. Pediatr. (Rio J.) vol.80 no.5 Porto Alegre 2004
LETTERS TO EDITOR
It was with great interest that we read the article published in the July/August 2004 issue on the neonatal use of corticosteroids.1 In the editorial that accompanied this article,2 it was mentioned that "...the use of antenatal corticosteroid therapy in preterm labor at less than 34 weeks reached 61%. As far as we know, this figure is much higher than in any other Latin American study," and, in addition to the BNRN , the Vermont-Oxford and NICHD were cited as examples of "multicentric networks".
There was, however, an omission in the form of the non-inclusion of the NEOCOSUR Collaborative Group, a neonatal network whose goal is to collect information, prospectively, on newborn babies weighing less than 1,500 g and their mothers. The network is made up of 16 neonatal units from five South-American countries (Argentina, Chile, Peru, Paraguay and Uruguay) and has accumulated data on, since 1997, a total of 3,812 preterms weighing less than 1,500 g at birth. We publish in scientific journals3 and have given several presentations at a variety of scientific meetings, Pediatric Academic Societies (PAS), Latin-American Pediatric Research Society (SLAIP - Sociedade Latino-americana de Pesquisa Pediátrica), Argentinean Society of Pediatrics National Research Meetings (Encuentro Nacional de Investigación Pediátrica) and the Chilean Pediatric and Neonatology congresses (Congreso Chileno de Pediatría and the Congreso Chileno de Neonatología).
The neonatal corticoid usage recorded on the NEOCOSUR database is, currently, 68.9% (51-100), greater than that reported in Montevideo, Uruguay,4 and of the study in question.1 These data confirm that, in our countries, the application of preventative measures, the effectiveness of which has already been proven in clinical trials, has spread to localized populations, even though we do still need to fight unceasingly to increase their use.
Perinatal Epidemiology and Biostatistics, Maternidade Sardá, Buenos Aires,
José Ceriani Cernadas
Chief of the Department
of Pediatrics, Hospital Italiano, Buenos Aires, Argentina.
1. Rede Brasileira de Pesquisas Neonatais. Uso neonatal de corticosteróide e evolução clínica de recém-nascidos pré-termo. J Pediatr (Rio J). 2004;80:277-84.
2. Barros F, Díaz-Rosello J. Redes multicêntricas e a qualidade de atenção neonatal. J Pediatr (Rio J). 2004;80:254-6.
3. Grupo Colaborativo Neocosur. Very-low-birth-weight infant outcomes in 11 South American NICUs. J Perinatol. 2002;22:2-7.
4. Matijasevich A, Barros F, Forteza C, Diaz-Rosello J. Atenção à saúde de crianças de muito baixo peso ao nascer, em Montevidéu, Uruguai: comparação entre os setores públicos e privado. J Pediatr (Rio J). 2001;77:313-20.
Resposta dos autores
We are grateful for the opportunity to reply to the letter from our colleagues Drs. Grandi and Ceriani Cernadas, from Buenos Aires. Initially we would like to say that, in our Editorial, we used the Vermont-Oxford Network and the North-American NICHD networks as being the best known, and that it was not our intention to cite all existing networks. The fact that the NEOCOSUR network was not included should not, therefore, be seen as an omission.
It is a cause of satisfaction to learn that the coverage of neonatal corticoid use for the NEOCOSUR network is "currently" 68.9%. In the group's publication,1 referring to 385 very low birth weight babies born at 11 centers in four South-American countries, the prevalence of prenatal corticoid usage was 56%. As such, this figure is lower than the 61% in the article on which our editorial commented.
The CLAP views with great enthusiasm the Brazilian Neonatal Research Network , initiative and also the work done by the NEOCOSUR network. The common objective of the improvement of the quality of neonatal care in Latin America and the Caribbean can be achieved by the work of teams with these characteristics. The collection of high quality epidemiological information at the population level that rank programs and assess the interventions made is indispensable.
José Luis Diaz Rossello
Centro Latino Americano de Perinatologia (CLAP) - OPAS/OMS, Montevideu, Uruguay.
1. Grupo Colaborativo Neocosur. Very-low-birth-weight infant outcomes in 11 South American NICUs. J Perinatol. 2002;22:2-7.