CONTEXTO E OBJETIVO: Em 2002, a mortalidade neonatal precoce brasileira foi 12,42 para cada mil nascidos vivos e a asfixia perinatal foi responsável por 23% dessas mortes. Este estudo visa avaliar a disponibilidade dos recursos necessários para a reanimação neonatal nas salas de parto de hospitais públicos brasileiros. TIPO DE ESTUDO E LOCAL: Estudo transversal multicêntrico de 36 maternidades, em 20 capitais brasileiras, em junho de 2003. MÉTODOS: As maternidades selecionadas em cada região brasileira representaram 1-4% dos nascidos vivos da região. O coordenador local da pesquisa respondeu a um questionário estruturado com dados a respeito da estrutura física, os equipamentos e o pessoal disponível para a reanimação neonatal em cada maternidade. A análise descritiva foi feita por meio do programa Statistical Package for Social Science 10.0. RESULTADOS: 89% das 36 maternidades eram referência para gestação de risco. Cada hospital tinha um número médio mensal de 365 nascimentos (3% < 1.500 g e 15% < 2.500 g). Os 36 hospitais tinham 125 mesas de reanimação (3-4/hospital), todas com calor radiante, fonte de oxigênio e vácuo. Equipamento adequado para ventilação pulmonar estava disponível em mais de 90% das 125 mesas. Em média, um pediatra, três enfermeiras e cinco auxiliares de enfermagem trabalhavam por turno nas salas de parto de cada instituição. Dos 874 pediatras e 1.037 profissionais de enfermagem que atuavam nas salas de parto, 94% e 22% haviam recebido treinamento em reanimação neonatal respectivamente. CONCLUSÕES: As maternidades públicas das capitais brasileiras apresentam salas de parto com infra-estrutura adequada para a reanimação neonatal.

CONTEXT AND OBJECTIVE: In 2002, the early neonatal mortality rate in Brazil was 12.42 per thousand live births. Perinatal asphyxia was the greatest cause of neonatal death (about 23%). This study aimed to evaluate the availability of the resources required for neonatal resuscitation in delivery rooms of public hospitals in Brazilian state capitals. DESIGN AND SETTING: Multicenter cross-sectional study involving 36 hospitals in 20 Brazilian state capitals in June 2003. METHODS: Each Brazilian region was represented by 1-4% of its live births. A local coordinator collected data regarding physical infrastructure, supplies and professionals available for neonatal resuscitation in the delivery room. The information was analyzed using the Statistical Package for the Social Sciences, version 10. RESULTS: Among the 36 hospitals, 89% were referral centers for high-risk pregnancies. Each institution had a monthly mean of 365 live births (3% < 1,500 g and 15% < 2,500 g). The 36 hospitals had 125 resuscitation tables (3-4 per hospital), all with overhead radiant heat, oxygen and vacuum sources. Appropriate equipment for pulmonary ventilation was available for more than 90% of the 125 resuscitation tables. On average, one pediatrician, three nurses and five nursing assistants per shift worked in the delivery rooms of each institution. Out of the 874 pediatricians and 1,037 nursing personnel that worked in the delivery rooms of the 36 hospitals, 94% and 22%, respectively, were trained in neonatal resuscitation. CONCLUSIONS: The main public maternity hospitals in Brazilian state capitals have the resources to resuscitate neonates at birth.

OBJETIVO: Analisar o ensino da reanimação neonatal para médicos e enfermeiros em formação e para residentes em pediatria e neonatologia em maternidades públicas brasileiras. MÉTODOS: Estudo transversal multicêntrico, realizado em 36 maternidades de 20 capitais brasileiras em junho de 2003. O coordenador local preencheu questionário com dados referentes à realização de ensino específico da reanimação neonatal e atuação em sala de parto de alunos de Medicina e de Enfermagem, residentes de Pediatria e de Neonatologia. Os dados foram analisados de forma descritiva. RESULTADOS: Das 36 maternidades, 23 recebiam alunos de Medicina: em 13, eles atuavam na sala de parto; 12 ofereciam ensino específico da reanimação e, em duas das 13 maternidades com internos atuando na sala de parto, não era oferecido treinamento em reanimação. Das 36 maternidades, 23 recebiam alunos de Enfermagem: em oito, os alunos atuavam na sala de parto. Apenas uma oferecia ensino, e nas outras sete não havia qualquer treinamento. Das 36 maternidades, 27 tinham residentes de Pediatria, que atuavam na sala de parto e recebiam treinamento em reanimação neonatal (teórico com 2-3 horas em quatro maternidades e teórico-prático com 4-64 horas em 23). Das 36 maternidades, 15 recebiam residentes em Neonatologia, que atuavam na sala de parto e recebiam treinamento em reanimação neonatal (teórico de 2 horas em uma e teórico-prático com 3-68 horas em 14). CONCLUSÃO: O ensino de reanimação por meio de cursos formais é insuficiente para os alunos de graduação em Medicina e Enfermagem e heterogêneo para os residentes em Pediatria e em Neonatologia.

OBJECTIVE: To analyze the teaching of neonatal resuscitation offered by Brazilian public hospitals to undergraduate doctors and nurses, pediatric residents and neonatal fellows. METHODS: This cross-sectional multicenter study included 36 hospitals in 20 Brazilian state capitals during June/2003. Local coordinators collected data regarding what the institutions offer to undergraduate doctors and nurses, pediatric residents and neonatal fellows in terms of neonatal resuscitation training and practical activities in neonatal delivery room care. Descriptive analysis was performed. RESULTS: Twenty-three of the 36 institutions had undergraduate doctors: at 13 of them students were given practical activities in the delivery room, 12 offered neonatal resuscitation training, and at two of the 13 hospitals, interns cared for neonates in the delivery room without specific training. Twenty-three of the 36 hospitals had undergraduate nurses: at eight of them students were given practical activities in the delivery room and at seven of them nursing students cared for neonates in the delivery room without specific training. Twenty-seven of the 36 institutions had pediatric residence programs: at all of them the trained residents cared for neonates in the delivery room, but this training was heterogeneous: theoretical training (2-3 hours) at four institutions and theoretical and practical training (4-64 hours) at 23. Additionally, 15 had neonatal fellowship programs: at all of these the trained fellows cared for neonates in the delivery room, but this training was heterogeneous: theoretical training (2 hours) at one hospital and theoretical and practical training (3-68 hours) at 14. CONCLUSION: Formal neonatal resuscitation training is insufficient during medical and nursing graduation and heterogeneously offered to pediatric residents and neonatal fellows.

OBJECTIVE: To detect the prevalence of systemic hypertension in children and to establish the relation between blood pressure levels and sex, age, ethnicity, weight, and height. METHODS: The prevalence of systemic hypertension and its relation to sex, age, ethnicity, weight, and height were studied in 611 students aged 7 to 14 years out of 19.928 students classified according to age, ethnicity, and sex, who underwent anthropometric evaluation and blood pressure measurement. Hypertensive individuals were considered those whose blood pressure level was > the 95th percentile for age and sex, confirmed on 3 examinations. RESULTS: The prevalence of hypertension was 16.6% in the first evaluation, and 4.6% and 2.5% in the subsequent evaluations. The mean blood pressure levels increased with age. Weight was important, not only to determine blood pressure in healthy children, but also to determine systemic hypertension in children, which was not observed with height despite the different studies. The prevalence of systemic hypertension in the different ethnic groups and the mean blood pressure levels according to sex were similar. CONCLUSION: In addition to routine physical examinations, age, weight, and appropriate cuff size should be considered when assessing blood pressure in children to prevent hypertension, morbidity and mortality, and to avoid placing a financial burden on health care providers.