Accesibilidad a una Unidad de Cuidados Intensivos Neonatales de alta complejidad en la Argentina

Introduccion. En la Argentina no existen datos acerca de cuantos recien nacidos (RN) que requieren ser internados en una unidad de mayor complejidad, lo hacen en tiempo y forma, ni cuales la evolucion de los que no acceden. Objetivo. Analizar las caracteristicas de los RN que requieren ser internados en una Unidad de Cuidados Intensivos Neonatales (UCIN) y describirla evolucion de aquellos que no acceden. Metodos. Estudio prospectivo, observacional y longitudinal. Se incluyeron los RN que solicitaron internacion en la UCIN del Hospital Garrahan durante once meses; se registro cada solicitud y se realizo el seguimiento telefonico de los RN rechazados. Se analizo mediante analisis bivariado y multivariado. Resultados. Solicitaron internacion 1197 RN; 75% con cuadro clinico grave; las patologias cardiacas, quirurgicas y respiratorias fueron las mas frecuentes. Se aceptaron 637 RN (53%). La procedencia del interior del pais (OR 2, IC95%: 1,4-2,8), la retinopatia del prematuro (OR 40, IC95%: 14-85) y la enfermedad quirurgica (OR 1,99, IC95%: 1,4-2,7) fueron factores independientes que aumentaron la posibilidad de acceso; esta disminuyo en los meses de invierno (OR 0,56, IC95%: 0,40-0,77). Fallecieron 56 RN, 47 de ellos no pudieron acceder a ningun centro de mayor complejidad a pesar de presentar patologias pasibles de tratamiento. Conclusion. Estos datos senalan la importancia de acordar estrategias regionales que permitan el empleo eficiente de los recursos instalados y el acceso oportuno de los RN graves a centros de mayor complejidad.(AU) Introduction. In Argentina information does not exist about how many newborns (NB) who need to be hospitalized in a third level neonatal intensive care unit (NICU) actually accede, not even about the evolution of those who cannot accede. Objective. To analize the characteristics of NB that required to be hospitalized in a NICU andthe evolution of those who do not accede. Methods. Longitudinal, prospective and observational study. There were included NB that requiredhospitalization in the NICU of the Hospital Garrahan during eleven months. Every request was registered and phone calls were made to know the evolution of rejected NB. The accessibility was analyzed by bivariated and multivariated tests. Results. 1197 NB were included in the study; 75%with severe clinical condition, being of higher frequency the cardiac, respiratory and surgical pathologies; 637 NB (53%) were accepted. The NBfrom other provinces (OR 2, IC95% 1.4-2.8), retinophaty of the premature (OR 40, IC95% 14-85) and surgical disease (OR 1.99, IC95% 1.4-2.7) wereindependent factors that increased the possibilities to access; it decreased during the winter (OR 0.56, IC95% 0.40-0.77); 56 NB died; 47 could not have access to a third level NICU in spite of presenting pathologies sensitive of treatment. Conclusion. This information shows the fact that is of high importance to define regional strategies that allow the efficient administration of existing health resources and the opportune access of seriously ill NB patients to reference centers.(AU)