Neonatal care in Brazil: hospital structure and adequacy according to newborn obstetric risk.
BACKGROUND
In Brazil, hospital birth care is available to all, but there are important differences between hospitals in the public and private sectors, geographical regions and capitals/inland cities, resulting in inequalities of infant health.


OBJECTIVE
To assess the hospital structure for birth care in Brazil and analyze hospital adequacy to care for newborns according to levels of risk.


METHODS
Data were collected as part of a nationwide hospital-based cohort study, 'Birth in Brazil'. The hospitals were classified according to whether they had a neonatal intensive care unit and divided into two models of governance: public and private financing. Three structure domains were assessed: human resources, medications and equipment for post-natal women and newborn emergency care. Newborns were classified according to the obstetric risk.


RESULTS
There are more NICUs in private hospitals and they cater mostly for low obstetric risk newborns; the public sector serves 50% of at-risk patients in hospitals without an NICU. The differences between hospital service structures according to geographic region and capital/inland cities were evident. Hospitals in less developed regions and inland cities had poorer adequacy in the three domains.


CONCLUSIONS
The distribution of neonatal care to Brazilian infants varied between the public and private sectors. The public sector offered less complex services for newborns at risk, and infants without obstetric risk were born in facilities with an NICU, creating the possibility of unnecessary intervention, especially in the private sector.
Sonia Duarte
SD
de Azevedo Bittencourt
Ricardo
R
Queiroz Gurgel
Maria Alexsandra
MA
da Silva Menezes
Leonardo S
LS
Bastos
Maria
M
do Carmo Leal
D001938:Brazil; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006298:Health Services Administration; D006302:Health Services Research; D054625:Healthcare Disparities; D006761:Hospitals; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D008297:Male
Maternal and child health,; Maternity hospitals,; Quality of health care; Structure of services,