Determinants of preterm infants’ deaths at the Neonatal Intensive Care Units in the Northeast Countryside in Brazil

Lima, Raquel Gomes; Vieira, Verônica Cheles; Medeiros, Danielle Souto de

doi:10.1590/1806-93042020000200012

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Saúde Materno Infantil

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 20 (2) • Apr-Jun 2020 • https://doi.org/10.1590/1806-93042020000200012 copy

Determinants of preterm infants’ deaths at the Neonatal Intensive Care Units in the Northeast Countryside in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to assess preterm infants’ characteristics, health conditions and neonatal care effect on their death at the neonatal ICU.

Methods:

this was a non-concurrent cohort study, including preterm infants from three neonatal ICUs from January 1st to December 31st, 2016, followed during the neonatal period and deaths registered during the entire hospitalization. Multivariate analysis was performed using Poisson regression.

Results:

of the 181 preterm infants, 18.8% died during hospitalization. Associated with the outcome: a gestational age between 28 and 32 weeks (RR= 5.66; CI95%= 2.08-15.40), and less than 28 weeks (RR=9.24; CI95%=3.27-26.12), Apgar score of 5th minutes less than 7 (RR: 1.82; CI95%=1.08-3.08), use of invasive mechanical ventilation up to 3 days (RR= 4.44; CI95%= 1.66-11.87) and 4 days and more (RR=6.87; CI95%=2.58-18.27). Besides the late sepsis (RR: 3.72, CI95%=1.77-7.83), acute respiratory distress syndrome (RR=2.86, CI95%=1.49-5.46), pulmonary hemorrhage (RR=1.97; CI95%=1.40-2.77), and necrotizing enterocolitis (RR= 3.41; CI95%=1.70-6.83).

Conclusions:

the results suggest the importance of using strategies to improve care during childbirth, conditions for extremely premature infants, early weaning from a mechanical ventilation and prevention on nosocomial infection.

Key words:
Premature newborn; Death; Neonatal ICU; Longitudinal studies

Variables	N	%
Sex
Male	108	59.7
Female	73	40.3
Maternal age (years)
<20	24	13.3
20-34	120	66.3
≥35	35	19.3
Ignored	2	1.1
Maternal race/color
White	34	18.8
Black/Mixed	113	62.4
Ignored	34	18.8
Marital status
With a partner	65	35.9
Without a partner	77	42.5
Ignored	39	21.6
Schooling
Without schooling/elementary	37	20.4
High school	53	29.3
Higher education	47	26.0
Ignored	44	24.3
Place of residence
Rural area	36	19.9
Urban area	144	79.6
Ignored	1	0.6

Variables	N	%	Death
Variables	N	%	n	%	RR_Crude	CI95%	RR_Adjusted	CI95%
Gestational age
Moderate/late preterm	113	62.4	5	4.4	1.00	-	1.00	-
Very preterm	46	25.4	16	34.8	7.86	3.05-20.25	4.44	1.66-11.87
Extremely preterm	22	12.2	13	59.1	13.35	5.28-33.75	6.87	2.58-18.27
Birth weight
Adequate /low weight	109	60.2	5	4.6	1.00	-	-	-
Very low weight	47	26.0	12	25.5	5.56	2.07-14.95	-	-
Extremely low weight	25	13.8	17	68.0	14.82	6.02-36.45	-	-
Apgar at the 5^th minute of life
<7	70	38.7	25	34.7	4.14	2.18-8.89	1.82	1.08-3.08
≥7	111	61.3	9	8.1	1.00	-	1.00	-
Resuscitation procedures
None	106	58.6	12	11.3	1.00	-	-	-
Positive pressure ventilation	57	31.5	12	21.1	1.85	0.89-3.87	-	-
Advanced resuscitation^* * Advanced resuscitation = positive pressure ventilation + cardiac massage and/or drugs; CPAP= continuous positive pressure (pressão positiva contínua).	18	9.9	10	55.6	4.90	2.49-9.64	-	-
Early CPAP in the delivery room
No	151	83.4	28	18.5	1.00	-	-	-
Yes	30	16.6	6	20.0	1.07	0.48-2.38	-	-
Use of surfactant
No	119	65.8	13	10.9	1.00	-	-	-
Yes	62	34.2	21	33.9	3.10	1.66-5.77	-	-
Use of central venous access
Up to 6 days	114	63.0	16	14.0	1.00	-	-	-
7 or more days	67	37.0	18	26.9	1.91	1.04-3.50	-	-
Use of mechanical ventilation
None	104	57.4	4	3.9	1.00	-	1.00	-
1 to 3 days	30	16.6	10	33.3	8.67	2.92-25.75	4.44	1.66-11.87
4 or more days	47	26.0	20	42.6	11.06	3.99-30.67	6.87	2.58-18.27

Variables	N	%	Death
Variables	N	%	n	%	RR_Crude	CI95%	RR_Adjusted	CI95%
Early sepsis
No	50	27.6	4	8.0	1.00	-	-	-
Yes	131	72.4	30	22.9	2.86	1.05-7.73	-	-
Late sepsis
No	117	64.6	8	6.8	1.00	-	1.00	-
Yes	64	35.4	26	40.6	5.94	2.85-12.37	3.72	1.77-7.83
Acute Respiratory Distress Syndrome
No	123	68.0	11	8.9	1.00	-	1.00	-
Yes	58	32.0	23	39.7	4.43	2.31-8.48	2.86	1.49-5.46
Pulmonary hemorrhage
No	179	98.9	32	17.9	1.00	-	1.00	-
Yes	2	1.1	2	100.00	5.59	4.08-7.66	1.97	1.40-2.77
Necrotizing enterocolitis
No	176	97.2	30	17.1	1.00	-	1.00	-
Yes	5	2.8	4	80.0	4.69	2.71-8.11	3.41	1.70-6.83

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Authors’ contribution

Study conception and design: Lima RG, Vieira VC, and Medeiros DS. Study implementation and collection: Lima RG and Viera VC. Statistical analysis and interpretation: Lima RG and Medeiros DS. Drafting: Lima RG. Critical review: Vieira VC and Medeiros DS. All authors approved the final version of the article.