Gestão de casos por enfermeiro na redução de complicações neonatais: estudo quase-experimental

Abstract

Abstract Objective To analyze the impact of nurse-mediated case management on prematurity, low birth weight, and neonatal mortality. Methods A pragmatic, quasi-experimental, single-arm, clinical trial, conducted in a city in the south of Brazil, with implementation of the nurse-mediated case management model as an intervention during ten months, in a sample of 91 pregnant women. The intervention consisted of nursing and multi-professional appointments, educational actions, home visits, and a telephone call. The data of the intervention group were compared to the data of births from 2016 to 2018 in the city, with calculation of the relative risk, the absolute risk reduction and the number needed to treat. Results Premature births accounted for 4.4% (95% CI 0.18%; 8.61%). Case management effectiveness in prematurity was 62%; for every 14 pregnant women in the intervention group, one premature birth was avoided. An absolute risk reduction of 7.3% was identified compared to previous city numbers. Newborns with low birth weight (<2500g) (p=0.975) were 8.9% of the total of neonates born, and neonatal mortality in the intervention group was not identified (p=0,850). Conclusion Nurse-mediated case management during pregnancy proved to be a strategy for prevention of prematurity and demonstrated the magnitude in neonatal mortality. However, regarding the birth weight, this model had no effectiveness. The regular presence of nurses is fundamental to improve the care during pregnancy. Brazilian Registry of Clinical Trials - ReBEC: RBR-1073gcfm nursemediated nurse mediated pragmatic quasiexperimental, quasiexperimental quasi experimental, experimental quasi-experimental singlearm, singlearm single arm, arm single-arm trial Brazil months 9 multiprofessional multi professional appointments actions visits call 201 treat 44 4 4.4 95% 95 (95 0.18% 018 0 18 8.61%. 861 8.61% . 8 61 8.61%) 62% 62 1 avoided 73 7 3 7.3 numbers <2500g 2500g g (<2500g p=0.975 p0975 p 975 (p=0.975 89 8.9 born p=0,850. p0850 p=0,850 850 (p=0,850) Nursemediated Nurse However ReBEC RBR1073gcfm RBRgcfm RBR 1073gcfm gcfm 20 4. (9 0.18 01 86 8.61 6 7. p=0.97 p097 97 (p=0.97 8. p085 p=0,85 85 (p=0,850 2 ( 0.1 8.6 p=0.9 p09 (p=0.9 p08 p=0,8 (p=0,85 0. p=0. p0 (p=0. p=0, (p=0,8 p=0 (p=0 (p=0, p= (p= (p