Mortalidad neonatal en niños con bajo peso al nacer

Estudio transversal que analizó datos de 771 nacidos vivos con bajo peso (<2.500g) en el municipio de Cuiabá, Estado de Mato Grosso, en 2010, de los que 54 fallecieron en el período neonatal. Se obtuvieron los datos del Sistema de Información de Nacidos Vivos y de Mortalidad, integrados por linkage.

Resultados

En la regresión logística múltiple, la mortalidad neonatal se asoció con: número de consultas pre natal menor de 7 (OR=3,80;IC:1,66-8,70); edad gestacional menor de 37 semanas (OR=4,77;IC:1,48-15,38), Apgar menor de 7 en el 1er minuto (OR=4,25;IC:1,84-9,81) y 5º minuto (OR=5,72;IC:2,24-14,60); y presencia de anomalía congénita (OR=14,39;IC:2,72-76,09).

Conclusión

La mortalidad neonatal en recién nacidos con bajo peso se asocia con factores que se pueden prevenir mediante una adecuada atención en el prenatal, parto y al mismo recién nacido.

Mortalidad infantil; Factores de riesgo; Recién nacido de bajo peso; Sistemas de información; Enfermería neonatal

Maternal characteristics ^* * Information was not obtained for all infant and mothers	Deaths n=54	Survivors n=717	Total	p-value ^ p-value refers to the Chi-square test. Note: n=771
	n(%)	n(%)	n(%)
Maternal age				0.035
<20	16 (29.6)	129 (18.0)	145 (18.8)
≥20	38 (70.4)	588 (82.0)	626 (81.2)
Maternal education				0.697
Elementary school (<8 year of study)	11 (20.4)	179 (25.0)	190 (24.6)
High school (8-12 years of study)	12 (22.2)	136 (19.0)	148 (19.2)
College (≥ 12 years of study)	31 (57.4)	402 (56.0)	433 (56.2)
Number of infant alive				0.939
<2	35 (77.8)	500 (77.3)	535 (77.3)
≥2	10 (22.2)	147 (22.7)	157 (22.7)
Ignored	9	70	79
Number of prenatal visits				<0.001
<7	43 (82.7)	298 (42.0)	341 (44.8)
≥7	9 (17.3)	411 (58.0)	420 (55.2)
Ignored	2	8	10
Type of labor				0.002
Vaginal	30 (55.6)	248 (34.6)	278 (36.1)
Cesarean	24 (44.4)	469 (65.4)	493 (63.9)
Infant’s characteristics *
Gender				0.034
Male	34 (63.0)	344 (48.0)	378 (49.0)
Female	20 (37.0)	373 (52.0)	393 (51.0)
Gestational age at birth				<0.001
<37	49 (90.7)	433 (60.7)	482 (62.8)
≥37	5 (9.3)	280 (39.3)	285 (37.2)
Ignored	0	6	4
1st minute Apgar				<0.001
<7	35 (67.3)	80 (11.2)	115 (15.0)
≥7	17 (32.7)	635 (88.8)	652 (85.0)
Ignored	2	2	4
5th minute Apgar				<0.001
<7	23 (43.4)	17 (2.4)	40 (5.2)
≥7	30 (56.6)	698 (97.6)	728 (94.8)
Ignored	1	2	3
Maternal characteristics*	Deaths n=54	Survivors n=717	Total	p-value**
Maternal characteristics*	n(%)	n(%)	n(%)	p-value**
Congenital malformation				0.001
No	50 (92.6)	707 (98.6)	757 (98.2)
Yes	4 (7.4)	10 (1.4)	14 (1.8)
Race/color of the baby				0.346
White	12 (35.3)	138 (27.8)	150 (28.2)
Not white	22 (64.7)	359 (72.2)	381 (71.8)
Ignored	20	220	240

Maternal characteristics ^* * Information was not obtained for all infant and mothers. Note: n=771	N	Deaths n(%)	Univariate analysis
	N	Deaths n(%)	OR Crude	95% IC
Maternal characteristics*	N	Deaths n(%)	Univariate analysis
Maternal characteristics*	N	Deaths n(%)	OR Crude	95% IC
Age
<20	145	16 (11.0)	1.92	1.04-3.55
≥20	626	38 (6.1)	1.00
Education
Elementary school (<8 year of study)	190	11 (5.8)	0.80	0.39-1.62
High school (8-12 years of study)	148	12 (8.1)	1.44	0.57-2.29
College (≥ 12 years of study)	433	31 (7.1)	1.00
Number of infant alive
<2	535	35 (6.5)	1.00
≥2	157	10 (6.3)	0.97	0.47-2.01
Number of prenatal visits
<7	341	43 (12.6)	6.60	3.16-13.72
≥7	420	9 (2.1)	1.00
Type of labor
Vaginal	278	30 (10.7)	1.00
Cesarean	493	24 (4.8)	2.36	1.35-4.13
Infant’s characteristics ^* * Information was not obtained for all infant and mothers. Note: n=771
Gender
Male	378	34 (9.0)	1.84	1.04-3.26
Female	393	20 (5.0)	1.00
Gestational age at birth
<37	482	49 (10.2)	6.34	2.49-16.01
≥37	285	5 (1.7)	1.00
1st minute Apgar
<7	115	35 (30.4)	16.34	8.75-30.51
≥7	652	17 (2.6)	1.00
5th minute Apgar
<7	40	23 (57.5)	31.48	15.24-65.04
≥7	728	30 (4.1)	1.00
Presence of congenital anomaly
No	757	50(6.6)	1.00
Yes	14	4 (28.5)	5.66	1.71-18.67

Variables	Multiple Model		p-valor
Variables	OR Adjusted	95%IC	p-valor
Number of prenatal visits
<7	3.80	1.66-8.70	0.002
≥7	1.00
Gestational age at birth
<37	4.77	1.48-15.38	0.010
≥37	1.00
1st minute Apgar
<7	4.25	1.84-9.81	<0.001
≥7	1.00
5th minute Apgar
<7	5.72	2. 24-14.60	<0.001
≥7	1.00
Presence of congenital anomaly
Yes	14.39	2.72-76-09	0.002
No	1.00

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence: Maria Aparecida Munhoz Gaiva.  Av. Fernando Corrêa da Costa, 2367 - Bairro Boa Esperança. CEP  78060-900 – Cuiabá, MT, Brasil. mamgaiva@yahoo.com.br