Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil

Rocha, Narayani Martins; Kale, Pauline Lorena; Fonseca, Sandra Costa; Brito, Alexandre dos Santos

doi:10.1590/1984-0462/2023/41/2021302

Acessibilidade / Reportar erro

Brasil

Revista Paulista de Pediatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021302 copy

Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil

Near miss e mortalidade neonatal e fatores associados: estudo de coorte de nascimentos do município do Rio de Janeiro, RJ

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015.

Methods:

Population-based retrospective cohort of live births (LB) of single pregnancy with 0–27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately.

Results:

The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added.

Conclusions:

Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers – low education level and brown or black skin colors – were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.

Keywords:
Near miss; Neonatal mortality; Prenatal care; Information systems; Maternal and child health

Characteristics	Survivors				Deaths		p-value^a
	No LTC (82,972)		Near Miss (1,404)		(509)
	n	%	n	%	n	%
Age group (years)							<0.001
<20	12,682	15.28	254	18.09	103	20.24
20–34	56,280	67.83	881	62.75	309	60.71
≥35	14,010	16.89	269	19.16	97	19.06
Level of education (years)							<0.001
<4	1,298	1.56	33	2.35	6	1.18
4–11	59,327	71.50	1,041	74.15	396	77.80
≥12	20,960	25.26	296	21.08	92	18.07
Ignored	1,387	1.67	34	2.42	15	2.95
Ethnicity/skin color^b							<0.001
White	30,713	37.02	461	32.83	134	26.33
Black	7,243	8.73	151	10.75	59	11.59
Brown	43,300	52.19	770	54.84	300	58.94
Others	303	0.37	6	0.43	1	0.20
Ignored	1,413	1.70	16	1.14	15	2.95
Have a partner							<0.001
No	54,369	65.53	990	70.51	366	71.91
Yes	28,008	33.76	402	28.63	131	25.74
Ignored	595	0.72	12	0.85	12	2.36
Deceased children							<0.001
None	67,109	80.88	1,097	78.13	377	74.07
≥1	15,574	18.77	299	21.30	131	25.74
Ignored	289	0.35	8	0.57	1	0.20
Living children							0.002
None	39,310	47.38	594	42.31	225	44.20
1–4	40,727	49.09	759	54.06	266	52.26
≥4	2,934	3.54	51	3.63	18	3.54
Ignored	1	≍0.0	–	–	–	–
Parity							0.220
Primiparous	35,673	42.99	635	45.23	217	42.63
Multiparous	47,192	56.88	765	54.49	292	57.37
Ignored	107	0.13	4	0.28	–	–

Characteristics	Survivors				Deaths		p-value^a
	No LTC (82,972)		Near Miss (1,404)		(509)
	n	%	n	%	n	%
Prenatal care							<0.001
No	565	0.68	33	2.35	25	4.91
Onset≤3^rd month	63,497	76.53	980	69.80	328	64.44
Onset>3^rd month	18,395	22.17	371	26.42	144	28.29
Ignored	515	0.62	20	1.42	12	2.36
Presentation^b							<0.001
Cephalic	78,350	94.43	–	–	406	79.76
Breech	2,535	3.06	–	–	78	15.32
Transverse	202	0.24	–	–	6	1.18
Ignored	1,885	2.27	–	–	19	3.73
Type of delivery							0.095
Vaginal	36,918	44.49	584	41.60	226	44.40
Cesarean	46,046	55.50	820	58.40	283	55.60
Ignored	8	≍0.0	–	–	–	–
Sex							0.017
Female	40,582	48.91	667	47.51	217	42.63
Male	42,385	51.08	737	52.49	288	56.58
Ignored	5	≍0.0	–	–	4	0.79

Hierarchical level/associated factors	Crude analysis				Adjusted analysis^a
Hierarchical level/associated factors	p-value	OR	95%CI		p-value	OR	95%CI
Independent
Male	0.303	1.06	0.95	1.17	–	–	–	–
Distal
Black skin color	0.001	1.38	1.15	1.67	0.002	1.34	1.11	1.62
Brown skin color	0.005	1.18	1.05	1.33	0.033	1.14	1.01	1.28
<8 years of formal education	0.001	1.19	1.04	1.35	0.043	1.15	1	1.31
Intermediate
<20 years	0.001	1.28	1.11	1.47	0.314	1.09	0.93	1.27
≥35 years	0.004	1.22	1.07	1.41	<0.001	1.33	1.15	1.54
Primiparous	0.084	0.91	0.82	1.01	0.01	0.86	0.76	0.96
Single	<0.001	1.27	1.13	1.42	0.005	1.2	1.06	1.37
Proximal
No prenatal care	<0.001	3.71	2.6	5.31	<0.001	3.72	2.57	5.38
Inadequate prenatal care	<0.001	1.31	1.16	1.47	<0.001	1.3	1.14	1.48

Hierarchical level/associated factors	Crude analysis				Adjusted analysis^a
Hierarchical level/associated factors	p-value	OR	95%CI		p-value	OR	95%CI
Independent
Male	0.008	1.27	1.06	1.52	0.008	1.27	1.06	1.52
Distal
Black skin color	<0.001	1.84	1.35	2.5	<0.001	1.82	1.34	2.49
Brown skin color	<0.001	1.57	1.28	1.93	<0.001	1.48	1.2	1.82
<8 years of formal education	0.003	1.37	1.11	1.69	0.048	1.24	1	1.54
Intermediate I
<20 years	0.001	1.84	1.17	1.84	0.031	1.3	1.03	1.65
≥35 years	0.05	1.26	1	1.58	0.009	1.37	1.08	1.74
Primiparous	0.926	1.01	0.85	1.2	–	–	–	–
Single^b	0.001	1.42	1.16	1.74	–	–	–	–
Intermediate II
No prenatal care	<0.001	7.55	4.99	11.42	<0.001	6.45	4.15	10.02
Inadequate prenatal care	<0.001	1.49	1.22	1.81	0.011	1.32	1.07	1.64
Non-cephalic presentation	<0.001	5.73	4.51	7.26	<0.001	5.6	4.35	7.23
Proximal
<2500g	<0.001	39.76	32.65	48.41	<0.001	8.06	5.86	11.09
<37 weeks	<0.001	28.62	23.37	35.05	<0.001	4.63	3.35	6.41
Five-minute Apgar score<7	<0.001	87.95	72.36	106.88	<0.001	29.54	23.04	37.86

Sociedade de Pediatria de São Paulo R. Maria Figueiredo, 595 - 10o andar, 04002-003 São Paulo - SP - Brasil, Tel./Fax: (11 55) 3284-0308; 3289-9809; 3284-0051 - São Paulo - SP - Brazil
E-mail: rpp@spsp.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. E-mail: narayanimartins@gmail.com (N. M. Rocha).