ABC | Volume 111, Nº5, November 2018

Original Article Lopes et al Mortality for critical congenital heart diseases and newborns Arq Bras Cardiol. 2018; 111(5):666-673 Figure 2 – Kaplan-Meier Curves and Cumulative Risk Function for Global Mortality for Congenital Heart Diseases. 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 0 5 15 25 35 45 55 65 75 85 95 105 115 125 135 145 155 165 175 185 195 205 215 225 0.0 0.2 0.6 0.8 0.4 Survival Days Hazard Global survival median = 74 days Survival Cumulative death risk Neonatal deaths due to congenital defects are classified by some authors, 23 and by the Brazilian Ministry of Health as avoidable, because they may be reduced for some conditions, if adequate and prompt assistance is offered to the pregnant woman and the newborn, aiming at the diagnosis and treatment, associated with adequate support by other spheres of the government – other than health services. 24 In addition, pathologies with this classification have the possibility of reducing mortality by such actions, depending on the condition considered. 25,26 The Ministry of Health recently launched a project to extend care to CHD children, 27 to reduce the mortality from these defects, which is in agreement with the findings in this study. This mobilization was necessary because it was estimated, within the national context, that up to 80% of newborns with CHD require a surgical procedure at some point in their development. Not infrequently, there is some demand for a surgical approach until late adolescence and early adulthood. 28 These data, while they may be underestimated, 29 should be monitored by independent and prospectively validated scientific investigations as the policy in question is being implemented. Limitations of the study Although the minimum sample size was calculated, considering the local prevalence of CHD in a pilot study, some variables could not be included in the regression model due to the numerical insufficiency, a consequence of the multivariate approach. The absence of statistical difference for survival rates, when the death event was compared within those who died from CHD and other causes (p = 0.076), is possibly related to the numerical insufficiency of this subgroup. In addition, in the period from September 2015 to January 2016, there was a substantial reduction in the number of occurrences of CHD from not yet well specified causes (data from the Department of Information Technology of the National Unified Health System – DATASUS, and direct observation in the collection of data), which resulted in longer collection time. Conclusion The high lethality rate of the disease in question demands critical attention for structuring a specialized care network, which can adequately serve the volume of neonates with congenital heart disease, as well as provide real investments in training and care technology, even within the neonatal age group. As an example, we can cite the policies that are directed to actions, aiming to deepen the scientific knowledge about the cardiopathies and their clinical interpellations. The neonatal mortality rate from critical congenital heart diseases was higher in this study than in countries with the same economic classification. In addition, this cohort was very quickly extinguished, which is very concerning, considering that death was the main outcome in very young patients, who did not have the opportunity to receive the specialized treatment. These findings point to the need for greater investment in care technology in populations with this profile. 670