Factors associated with hospitalization and neonatal mortality in a cohort of newborns from the Unified Health System in São Paulo

Moura, Bárbara Laisa Alves; Alencar, Gizelton Pereira; Silva, Zilda Pereira da; Almeida, Márcia Furquim de

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 23 • 2020 • https://doi.org/10.1590/1980-549720200088 copy

Factors associated with hospitalization and neonatal mortality in a cohort of newborns from the Unified Health System in São Paulo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

Newborn care is an important factor associated with hospitalization and neonatal mortality.

Objective:

To analyze factors associated with hospitalization and neonatal mortality of newborns (NBs) admitted to the Unified Health System (SUS), São Paulo, 2012.

Methods:

A cohort of NBs from the SUS was obtained by linking data: SUS Hospital Information System, Live Birth Information System, Mortality Information System and National Health Facility Registry. Poisson and Cox regression were performed.

Results:

16.5% (9,127) of the NBs were hospitalized, 4.7% (2,613) were admitted to a Neonatal Intensive Care Unit (NICU) and 11.8% (6,514) to a Neonatal Intermediate Care Unit (NIMCU). Maternal age ≥ 35 years (RR = 1.1, IC95% 1.1 - 1.2), inadequate prenatal care (RR = 1.2, IC95% 1.1 - 1.3), hospitalization for obstetric complications (RR = 1.1, IC95% 1.1 - 1.2), prematurity (≤ 32 weeks: RR = 1.6, IC95% 1.5 - 1.8; 32 to 36 weeks: RR = 1.7, IC95% 1.6 - 1,7), low weight (< 1,500 g: RR = 2.4, IC95% 2.1 - 2.6; 1,500 to 2,499 g: RR = 2.6, IC95% 2.5 - 2.7), APGAR 5º < 7 (RR = 1.9, IC95% 1.7 - 2.0), Cesarean section (RR = 1.1, IC95% 1.1 - 1.2) and Congenital Malformation (RR = 1.4, IC95% 1.3 - 1,5) were associated with the hospitalization of newborns. Neonatal mortality was associated with infants under 1,500 g (RR = 9.1, IC95% 6.3 - 13.1), very premature (RR = 2.6, IC95% 1.9 - 3.5), low APGAR (RR = 5.5, IC95% 4.6 - 6.7).

Conclusion:

Inadequate prenatal care, prematurity and low weight were risk factors for hospitalization and neonatal mortality.

Keywords:
Intensive Care Units; Neonatal. Neonatal mortality. Cohort Studies. Unique Health System

Characteristics	NB	HNB	GRR	95%CI	ARR	95%CI
Mothers’ age (years)
< 20	11,110	1,840	1	1.0 - 1.1
20 to 34	38,128	6,053	1
≥ 35	6,164	1,234	1.3	1.0 - 1.3	1.1	1.1 - 1.2
Race/color
Non-White/Caucasian	33,164	5,211	0.9	0.1 - 0.9	0.9	0.8 - 0.9
White/Caucasian	22,238	3,916	1
Prenatal (number of medical appointments)
< 4	4,937	1,351	1.8	2.0 - 1.9	1.2	1.1 - 1.3
4 to 6	12,515	2,396	1.3	1.0 - 1.3
≥ 7	37,950	5,380	1
Hospitalization due to obstetric complications
Yes	52,585	774	1.6	1.5 - 1.7	1.1	1.1 - 1.2
No	2,817	8,353	1
Type of delivery
Vaginal	37,181	5,394	1
Cesarean	18,221	3,733	1.3	1.3 - 1.4	1.1	1.1 - 1.2
Gestational age (in weeks)
≤ 32	994	818	4.8	5.0 - 5.1	1.6	1.5 - 1.8
32 to 36	5,397	2,199	3.7	4.0 - 3.9	1.7	1.6 - 1.7
≥ 37	49,011	6,110	1
Weight (grams)
< 1.500	880	777	5.2	5.0 - 5.6	2.4	2.1 - 2.6
1.500-2.499	4,391	2,251	3.7	4.0 - 3.9	2.6	2.5 - 2.7
≥ 2.499	50,131	6,099	1
APGAR at 5 minutes
< 7	695	524	3.8	4.0 - 4.1	1.9	1.7 - 2.0
≥ 7	54,707	8,603	1
Congenital malformation
Yes	1,013	387	2.1	2.0 - 2.3	1.4	1.3 - 1.5
No	54,389	8,740	1

Characteristics	NICU		NIMCU		Not hospitalized		Total
Characteristics	(N = 2,613)	%	(N = 6,514)	%	(N = 46,275)	%	(N = 55,402)
Gender
Male	1,415	5.0	3,459	12.3	23,324	82.7	28,198
Female	1,198	4.4	3,055	11.2	22,951	84.4	27,204
Weight (grams)
< 1.500	546	62.0	231	26.2	103	11.7	880
1.500 - 2.499	893	20.3	1,358	30.9	2,140	48.7	4,391
≥ 2.500	1,174	2.3	4,925	9.8	44,032	87.8	50,131
Gestational age
< 32	557	56.0	261	26.3	176	17.7	994
32 to 36	909	16.8	1,290	23.9	3,198	59.3	5,397
≥ 37	1,147	2.3	4,963	10.1	42,901	87.5	49,011
Apgar at 5 minutes
< 7	329	47.3	195	28.1	171	24.6	695
≥ 7	2,284	4.2	6,319	11.5	46,104	84.3	54,707

Characteristics	LB	NM	GHR	95%CI	AHR	95%CI
Prenatal (Number of medical appointments)
< 4	1,351	173	5.6	4.5 - 6.9	1.2	1.1 - 1.5
4 to 6	2,396	180	3.1	2.5 - 3.9
≥ 7	5,380	127	1
Gestational age (weeks)
≤ 32	818	306	25.5	21.0 - 32.0	2.6	1.9 - 3.5
32 to 36	2,199	67	1.7	1.2 - 2.3
≥ 37	6,110	107	1
Weight (grams)
< 1.500	777	328	34.4	28.0 - 43.0	9.1	6.3 - 13.0
1.500-2.499	2,251	61	1.8	1.3 - 2.4
≥ 2.499	6,099	91	1
Apgar at 5 minutes
< 7	524	206	16.2	14.0 - 19.0	5.5	4.6 - 6.7
≥ 7	8,603	274	1
Pregnancy
Single	8,727	428	1
Multiple	400	52	2.9	2.2 - 3.9	1.5	1.2 - 2.1
Congenital malformation
Yes	387	115	8.3	6.7 - 10.0	6.4	5.2 - 7.9
No	8,740	365	1

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E-mail: revbrepi@usp.br

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[1] Corresponding author: Bárbara Laisa Alves Moura. Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. Rua Alvorada, 153, apto. 73, CEP: 04550-000, São Paulo, SP, Brasil. E-mail: blamoura@hotmail.com