Early neonatal mortality and risk factors: a case-control study in Paraná State

to analyze the Early Neonatal Mortality risk factors according to the risk stratification criteria of the Guideline of the Rede Mãe Paranaense Program.

Method:

a case-control epidemiological study with secondary data from the Mortality and Live Birth Information System in 2014. The crude analysis was performed by the Odds Ratio association measure, followed by the adjusted analysis, considering risk factors as independent variables, and early neonatal death as dependent variable.

Results:

were considered as maternal risk factors: absence of partner and miscarriages; neonatal: male, low birth weight, prematurity, Apgar less than seven in the fifth minute, presence of congenital anomaly; and care: up to six prenatal appointments.

Conclusion:

an innovative study of risk factors for early neonatal death from the Guideline's perspective, a technological management tool for maternal and child health, in search of its qualification and greater sensitivity.

Descriptors:
Early Neonatal Mortality; Risk Factors; Public Health Nursing; Nursing; Information Systems

Variables	Control Groups		Case Groups		Crude OR^* * Odds Ratio,			Adjusted OR^* * Odds Ratio,
Variables	n	%	n	%	OR^* * Odds Ratio,	CI 95%^ Confidence Level of 95%,	p ^* ***** P value.	OR^* * Odds Ratio,	CI 95%^ Confidence Level of 95%,	p ^* ***** P value.
Group 1: Socioeconomic Maternal Conditions Variables
Mother's Age (years)
Up tp 19	28056	17.8	204	22.6	1.40	1.20 - 1.65	< 0.0001	1.03	0.82 - 1.28	0.803
From 20 to 34	114280	72.5	592	65.6	1.00	-	-	1.00	-	-
Over 35	15292	9.7	107	11.8	1.35	1.10 - 1.66	0.005	1.11	0.85 - 1.45	0.451
Not informed	1	0.0	0	0.0
Schooling (years)
< 8	62023	39.3	574	39.3	11.46	10.00 - 13.13	< 0.0001	1.27	0.94 - 1.34	0.187
≥ 8	94994	60.3	327	60.3	1.00	-		1.00	-	-
Not informed	612	0.4	2	0.4
Marital Status
With a partner	60498	38.4	272	30.1	1.00	-	-	-	-	-
Without a partner	96433	61.2	624	69.1	1.44	1.25 - 1.66	< 0.0001	1.22	1.00 - 1.49	0.043
Not informed	698	0.4	7	0.8
Race
White and yellow	120061	76.2	686	76.0	1.00	-	-
Brown	31659	20.1	181	20.0	1.00	0.85 - 1.18	0.9723
Black	3760	2.4	22	2.4	1.02	0.67 - 1.57	0.9996	-	-	-
Indigenous	471	0.3	3	0.3	1.11	0.36 - 3.48	0.9054
Not informed	1678	1.1	11	1.2
Group 2: Obstetric Variables
Alive Children
≤ 2	144702	91.8	818	91.8	1.00	-	-	-	-	-
≥ 3	11791	7.5	85	7.5	1.27	1.02 - 1.59	0.0386	1.02	0.753 - 1.39	0.880
Not informed	1136	0.7	0	0.7
Miscarriages
No	132839	84.3	714	79.1	1.00	-	-	1.00	-	-
Yes	23390	14.8	188	20.8	1.49	1.27 - 1.76	< 0.0001	1.25	1.00 - 1.55	0.041
Not informed	1400	0.9	1	0.1
Type of Pregnancy
Single	154261	97.8	790	97.8	1.00	-	-	1.00	-	-
Multiple	3263	2.1	113	2.1	6.76	5.53 - 8.26	< 0.0001	0.96	0.72 - 1.29	0.810
Not informed	105	0.1	0	0.0
Group 3: Newborn Variables
Gender
Female	76774	48.7	399	44.2	1.00	-	-	1.00	-	-
Male	80847	51.3	496	54.9	1.18	1.03 - 1.35	0.0151	1.35	1.14 - 1.60	0.001
Not informed	8	0.0	8	0.9
Weight (g)
< 1.000	503	0.3	385	42.6	577.16	475.36 - 700.75	< 0.0001	36.60	25.83 - 51.84	0.000
From 1.000 to 2.499	12337	7.8	326	36.1	19.92	16.65 - 23.84	< 0.0001	4.43	3.42 - 5.73	0.000
≥ 2.500	144779	91.8	192	21.3	1.00	-	-	1.00		-
Not informed	10	0.0	0	0.0
Gestational Age (week)
> 37	140477	89.1	212	23.5	1.00	-	-	1.00	-	-
From 32 to 37	13893	8.8	170	18.8	8.11	6.62 - 9.93	< 0.001	2.33	1.78 - 3.03	0.000
< 32	1791	1.1	516	57.1	190.90	161.62 - 225.50	< 0.001	6.98	5.10 - 9.54	0.000
Not informed	1468	0.9	5	0.6
Ápgar 5^thmin (scores)
< 7	1607	1.0	480	53.2	110.93	96.45 - 127.58	< 0.0001	13.93	11.43 - 16.97	0.000
≥ 7	155982	98.9	420	46.5	1.00	-	-	1.00	-	-
Not informed	40	0.0	3	0.3
Congenital Anomaly
No	156333	99.2	742	82.2	1.00	-	-	1.00	-	-
Yes	954	0.6	159	17.6	35.11	29.25 - 42.15	< 0.0001	21.82	16.74 - 28.44	0.000
Not informed	342	0.2	2	0.2
Group 4: Assistance Variables
Prenatal Onset
1^st Quarter	129524	82.2	666	73.8	1.00	-	-	1.00	-	-
2^nd or 3^rd Quarter	22838	14.5	149	16.5	1.27	1.06 - 1.52	0.0100	1.10	0.87 - 1.41	0.399
Not informed	5267	3.3	88	9.7
Number of Appointments
From 0 to 6	29488	18.7	539	59.7	6.82	5.95 - 7.82	0.0001	1.53	1.25 - 1.87	0.000
≥ 7Not informed	127643498	81.00.3	34222	37.92.4	1.00	-	-	1.00	-	-
Type of Labor
Normal	57714	36.6	435	48.2	1.00	-	-	1.00	-	-
C-section	99847	63.3	468	51.8	0.62	0.54 - 0.70	< 0.0001	1.01	0.85 - 1.22	0.865
Not informed	68	0.0	0	0.0

Adjusted Variable	OR adj^* * Adjusted Odds Ratio;	CI 95%^ Confidence Interval of 95%;	p^ ***** P value.*	Guideline Classification
Maternal socioeconomic conditions
Without partner	1.22	1.00 - 1.49	0.043	Not included
Obstetric
Miscarriages	1.25	1.00 - 1.55	0.041	Intermediate risk of the pregnant woman
Of the Newborn
Male	1.35	1.14 - 1.60	0.001	Not included
Extreme premature (<32 week)	6.98	5.10 - 9.54	0.000	Not included
Apgar < 7 in the fifth minute	13.93	11.43 - 16.97	0.000	High risk of the child
Presence of congenital anomaly	21.82	16.74 - 28.44	0.000	Not included
Low birth weight (< 1.000g)	36.60	25.83 - 51.84	0.000	High risk of the child
Assistance
Up to six prenatal appointments	1.53	1.25 - 1.87	0.000	Not included

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[1] CORRESPONDING AUTHOR: Márcia Helena de Souza Freire. E-mail: marciahelenafreire@gmail.com