PERINATALNA ZAŠTITA U HRVATSKOJ Jučer, danas, sutra

Ante Dražančić, Urelija Rodin, Boris Filipović-Grčić

Sažetak. Prikazani su pokazatelji perinatalne zaštite u Hrvatskoj te njezine odrednice. Maternalni je mortalitet nizak, manji je od 10/100.000, na razini je razvijenih zemalja. Perinatalni mortalitet nakon stagnacije od oko 9,0‰ od 1990. do 2000. ¬godine, smanjuje se za ukupno perinatalno umrle na 7,8‰, a za umrle ³1000 grama odnosno ³28 tjedana na 5,8‰. Fetalni mortalitet dalje stagnira, na oko 4,0‰, a rani neonatalni mortalitet se od 4,0 do 5,0‰ smanjuje na 1,9‰. Analizirane su odrednice perinatalne zaštite i mortaliteta. Nedonošenost i rađanje djece niske (4–5%), vrlo niske (oko 0,6%) i izrazito niske (oko 0,4%) porodne težine na razini je razvijenih zemalja. Antenatalna skrb je u stalnom poboljšanju: povećava se broj pregleda, na više od 8,1 pregleda po trudnoći i na više od 50% njih s 9 i više pregleda; prosječni broj pregleda ultrazvukom popeo se na 3,97 po trudnici, njih 59% ima 4 ili više pregleda po trudnoći; te vrijednosti zaostaju za vrijednostima zemalja s vrlo niskim mortalitetom. U vođenju poroda u stalnom je porastu broj poroda dovršenih carskim rezom, na 15,5%. U neonatalnoj je skrbi u posljednjih 10 godina stalno nizak rani neonatalni mortalitet djece ³2500 g, znatno je snižen u djece 1000–1499 i 1500–2499 g, ali je nedovoljno sniženje u skupini 500–999 g. Izrazit je manjak neonatološke opreme i supspecijalista neonatologa, posebice u 6 postojećih jedinica intenzivnoga neonatalnog liječenja (JINT). Regionalna organizacija perinatalne zaštite provodi se voluntaristički, nije institucionalizirana. U rodilištima III. razine, s JINT rođeno je 2004. godine 67,7% od sve djece <1500 g i 73,4% živorođene djece. Analizirani su uzroci i regionalne razlike perinatalnog mortaliteta. Da bi se u budućnosti nastavio pozitivni trend smanjenja i postizanje stopa izrazito niskog perinatalnog mortaliteta (<5,0‰), potrebna je institucionalizacija regionalnog ustroja perinatalne zaštite, funkcioniranje JINT s dovoljnom opremom i daljnja edukacija supspecijalista iz neonatalne i materno-fetalne medicine.

Summary. The indicators and determinants of perinatal care in Croatia are presented. The maternal mortality is low, less than 10/100.000, at a level of developed countries. The perinatal mortality, following stagnation during 10 years at a level of around 9.0‰, since 2001 started to decrease for all perinatally dead up to the rate of 7.8‰, and for those ³1000 grams or ³27 weeks up to 5.8‰. The fetal mortality continues to be stagnant at a rate of about 4.0‰, while the early neonatal mortality continues to decrease up to the rate of 1.9‰. The determinants of perinatal care and mortality are analyzed. The pre-term deliveries and the births of low birthweight infants (4–6%), of very low birthweight infants (0.6%) and of extremely low birthweight infants (0.4%) are at the level of developed countries. The antenatal care is continuously improving: the average number of antenatal visits increased to 8.1, over 50% of pregnant patients had 9 or more visits; the average number of ultrasound examinations increased to 3.97, 59% of them had 4 or more US examinations; these values do not correspond to the values in very developed countries with very low perinatal mortality. The rate of Cesarean sections increased to 15.5%. In neonatal care during last 10 years the early mortality of infants ³2500 grams was continuously low , the early mortality of infants 1000–1499 grams and of 1500–2499 grams is remarkably decreased, but the decrease in those of 500–999 grams was not substantial. In neonatal care the lack of equipment and of specialists neonatologists, especially in NICU-s is registered. Regional organization of perinatal care is voluntary, it is not legally instituted. During 2004, 67.7% of all infants and 73.4% of live-born infants with birthweight <1500 grams in the 3rd level materity wards with NICU were delivered. The causes and
regional differences in perinatal mortality are analyzed. With the aim to continue in the future the positive trend, and to achieve a very low perinatal mortality (<5.0‰), regional organization of perinatal care, functioning of NICU with adequate equipment, and further education of specialists in neonatology and fetal-maternal medicine should be institutionally established.