Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil

Garcia, Leandro Pereira; Fernandes, Camila Mariano; Traebert, Jefferson

doi:10.1016/j.jped.2017.12.007

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Original articles • J. Pediatr. (Rio J.) 95 (2) • Mar-Apr 2019 • https://doi.org/10.1016/j.jped.2017.12.007 copy

Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil^☆ ☆ Please cite this article as: Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. J Pediatr (Rio J). 2018. https://doi.org/10.1016/j.jped.2017.12.007 , ^☆☆ ☆☆ Study carried out at Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate.

Method:

Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression.

Results:

Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death.

Conclusion:

Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.

KEYWORDS
Mortality; Newborn; Risk factors

Risk factors	n (%)	X ²	p
Socioeconomic risk factors
Maternal schooling (n = 15,804)		1.6	0.22
High	6198 (39.21)
Low	9606 (60.71)
Maternal marital situation (n = 15,804)		0.06	0.81
With partner	11,389 (72.07)
Without partner	4415 (27.93)
Behavioral and health service use risk factors
Number of prenatal consultations (n = 15,445)		110.98	<0.01^a a Variables selected for multiple regression.
Sufficient	11,154 (72.85)
Insufficient	4291 (27.15)
Type of health service (n = 15,879)		86.80	<0.01^a a Variables selected for multiple regression.
SUS	9341 (60.48)
Private	6538 (39.52)
Type of delivery (n = 15,860)		0.18	0.67
Vaginal	7380 (46.53)
C-section	8480 (53.47)
Apgar score and biological risk factors
Apgar score at the 1st minute (n = 15,800)		699.50	<0.01^a a Variables selected for multiple regression.
High	15,007 (94.98)
Low	793 (5.02)
Apgar score at the 5th minute (n = 15,805)		2427.00	<0.01^a a Variables selected for multiple regression.
High	15,671 (99.15)
Low	134 (0.85)
Birth weight (n = 15,804)		737.91	<0.01^a a Variables selected for multiple regression.
No low birth weight	14,609 (92.00)
Low birth weight	1269 (8.00)
Weeks of pregnancy (n = 15,825)		569.83	<0.01^a a Variables selected for multiple regression.
Not preterm	14,257 (90.09)
Preterm	1568 (9.91)
Gender (n = 15,876)		3.18	0.07^a a Variables selected for multiple regression.
Female	7776 (48.98)
Male	8100 (51.02)
Identified malformation (n = 15,843)		92.09	<0.01^a a Variables selected for multiple regression.
No	15,638 (98.70)
Yes	205 (1.30)
Type of pregnancy (n = 15,857)		127.54	<0.01^a a Variables selected for multiple regression.
Single	15,434 (97.33)
Multiple	423 (2.67)
Maternal age (n = 15,879)		3.21	0.07
≥35 years	12,837 (80.84)
<35 years	3042 (19.16)

Risk factors	_crudeOR (95%CI)	p	_adjustedOR (95%CI)	p
Socioeconomic risk factors
Maternal schooling
High	1.00
Low	1.34 (0.84-2.18)	0.22
Maternal marital situation
With partner	1.00
Without partner	1.06 (0.64-1.71)	0.81
Behavioral and health service use risk factors
Number of prenatal consultations
Sufficient	1.00		1.00
Insufficient	9.81 (5.75-17.58)	<0.01	3.04 (1.61-5.97)	<0.01
Type of health service
SUS	1.00
Private	0.49 (0.29-0.81)	<0.01
Type of delivery
Vaginal	1.00
C-section	0.91 (0.58-1.43)	0.67
Apgar score and biological risk factors
Apgar score on the 1st minute
High	1.00		1.00
Low	42.90 (26.53-71.03)	<0.01	6.08 (3.10-11.68)	<0.01
Apgar score on the 5th minute
High	1.00		1.00
Low	168.94 (102.43-281.97)	<0.01	19.08 (8.78-42.92)	<0.01
Birth weight
Without low birth weight	1.00		1.00
Low birth weight	83.31 (43.82-174.68)	<0.01	9.46 (4.06-23.60)	<0.01
Weeks of pregnancy
Not preterm	1.00		1.00
Preterm	64.04 (33.77-134.08)	<0.01	6.09 (2.58-15.23)	<0.01
Gender
Female	1.00
Male	1.49 (0.94-2.38)	0.07
Identified malformation
No	1.00		1.00
Yes	12.08 (5.69-23.38)	<0.01	6.12 (2.14-15.67)	<0.01
Type of pregnancy
Single	1.00
Multiple	10.94 (6.14-18.67)	<0.01
Maternal age
≥35 years	1.00
<35 years	1.54 (0.91-2.53)	0.07

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[1] * Corresponding author. E-mail:lpgarcia18@gmail.com (L.P. Garcia).