Avoidable deaths in the first 24 hours of life: health care reflexes

cross-sectional study carried out in Pernambuco, Northeast of Brazil, between 2000-2019, with mortality and live birth data. The avoidability was analyzed through the Brazilian List of Avoidable Causes of Deaths due to Interventions of the Unified Health System. For the statistical analyses, Pearson’s chi-squared test and relative and attributable risks were used.

Results:

13,601 deaths were registered, of which 10,497 (77.19%) were from preventable causes. Of the total, 5,513 (40.53%) were reducible through adequate care for women during pregnancy. The lower the gestational age, birth weight and education level, the higher the relative and attributable risk of death in the first 24 hours of life.

Conclusions:

most of the deaths were considered avoidable and with high relative and attributable risks. These early deaths suggest care failures and the need to reinforce prevention and treatment measures.

Descriptors:
Causes of Death; Child Mortality; Neonatal Mortality; Information Systems; Vital Statistics.

Variables	n (%)	LB^a a LB - live birth;	Rate	RR^b b RR - relative risk;	AR^c c CI - Confidence Interval 95%;	p value^*
DISTAL
Maternal Education (in years of study)						<0.01
No education	1,011 (7.43)	111,091	9.10	3.37 (3.08;3.69)	6.40 (5.81;6.99)
1 to 3	1,538 (11.31)	318,818	4.82	1.79 (1.65;1.94)	2.12 (1.83;2.43)
4 to 7	3,879 (28.52)	907,848	4.27	1.58 (1.47;1.70)	1.57 (1.36;1.80)
8 to 11	4,112 (30.23)	1,181,929	3.48	1.29 (1.20;1.39)	0.78 (0.58;0.99)
≥12	912 (6.71)	338,175	2.70	1.00	(Reference)
INTERMEDIARY
Type of labor						<0.01
Vaginal	9,612 (70.67)	1,634,034	5.88	1.00	(Reference)
C-section	2,949 (21.68)	1,261,935	2.34	0.40 (0.38;0.41)	-3.54 (-3.69; -3.40)
PROXIMAL
Gestational Age (in weeks)						<0.01
< 22	1,488 (10.94)	1,738	856.16	744.48 (715.35;775.80)	855.01 (838.51;871.51)
22 to 27	3,629 (26.68)	11,842	306.45	266.48 (254.97;278.87)	305.30 (297.00;313.61)
28 to 36	4,026 (29.60)	216,443	18.60	16.17 (15.44;16.96)	17.45 (16.88;18.02)
≥37	3,012 (22.15)	2,620,821	1.15	1.00	(Reference)
Sex						<0.01
Male	7,604 (55.91)	1,484,230	5.12	1.26 (1.21;1.30)	1.04 (0.88;1.19)
Female	5,776 (42.47)	1,414,101	4.08	1.00	(Reference)
Birth Weight (in grams)						<0.01
< 1.500	7,089 (52.12)	34,553	205.16	181.56 (174.34;189.34)	204.03 (199.78;208.29)
1.500 to 2.499	2,289 (16.83)	186,425	12.28	10.87 (10.30;11.48)	11.15 (10.65;11.65)
≥2.500	3,017 (22.18)	2,671,807	1.13	1.00	(Reference)
Type of Pregnancy						<0.01
Singlet	11,341 (83.38	2,844,106	3.99	1.00	(Reference)
Double	1,221 (8.98)	51,240	23.83	5.97 (5.64;6.34)	19.84 (18.52;21.16)
Triple or more	62 (0.46)	1,481	41.86	10.49 (8.22;13.40)	37.87 (27.68;48.08)
Maternal Age (in years)						<0.01
10 to 19	3,351 (24.64)	640,631	5.23	1.38 (1.33;1.44)	1.44 (1.25;1.64)
20 to 34	7,512 (55.23)	1,983,743	3.79	1.00	(Reference)
≥35	1,278 (9.40)	273,865	4.67	1.23 (1.16;1.31)	0.88 (0.61;1.14)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Cristine Vieira do Bonfim, E-mail: cristine.bonfim@uol.com.br

1. AVOIDABLE CAUSES	10,497 (77.19)
1.1 Reduced by immunoprevention actions	3(0.02)
Congenital Rubella Syndrome	2 (0.01)
Meningitis caused by Haemophilus	1 (0.01)
1.2 Reduced by adequate care for women during pregnancy	5,513 (40.53)
Disorders related to short-term pregnancy and low birth weight	1,534 (11.28)
Respiratory distress syndrome of the newborn	1,146 (8.43)
Maternal pregnancy complications that affect the fetus or newborn	1,118 (8.22)
Maternal conditions affecting the fetus or newborn	911 (6.70)
Fetus and newborns affected by complications of the placenta and membranes	561 (4.12)
Congenital syphilis	83 (0.61)
Delayed fetal growth and fetal malnutrition	59 (0.43)
Pulmonary hemorrhage originating in the perinatal period	45 (0.33)
Hemolytic diseases of the fetus or newborn due to isoimmunization	21 (0.15)
Rh and ABO isoimmunization of the fetus or newborn	17 (0.12)
Non-traumatic intracranial hemorrhage of the fetus and newborn	11 (0.08)
Human immunodeficiency virus diseases	1 (0.01)
1.3 Reduced by adequate care for women in childbirth	2,639 (19.40)
Intrauterine hypoxia and birth asphyxia	1,502 (11.04)
Neonatal aspiration (except regurgitated breast milk)	406 (2.99)
Placenta previa and placental abruption	323 (2.37)
Other complications of labor or delivery that affect the newborn	209 (1.54)
Fetus and newborn affected by umbilical cord disorders	151 (1.11)
Delivery trauma	47 (0.35)
Disorders related to prolonged pregnancy and high birth weight	1 (0.01)
1.4 Reduced by adequate attention to the fetus and the newborn	2,263 (16.64)
Respiratory disorders specific to the perinatal period	1,474 (10.84)
Specific infections of the perinatal period (except for MMR^ MMR - Measles, Mumps and Rubella. and congenital viral hepatitis)	466 (3.43)
Conditions that compromise the integument and thermal regulation of the newborn	101 (0.74)
Other disorders originating in the perinatal period	100 (0.74)
Neonatal hemorrhage	43 (0.32)
Newborn and specific transient endocrine and metabolic disorders	35 (0.26)
Hematological disorders of the newborn	29 (0.21)
Digestive system disorders of the newborn	13 (0.10)
Other perinatal jaundices	2 (0.01)
1.5 Reduced by adequate diagnostic and treatment actions	21 (0.15)
Down's syndrome	14 (0.10)
Pneumonia	3 (0.02)
Other bacterial diseases	3 (0.02)
Acute upper airway infections	1 (0.01)
1.6 Reduced by adequate health promotion actions, linked to adequate health care actions	58 (0.43)
Sudden infant death syndrome	21 (0.15)
Events whose intent is intermediary	14 (0.10)
Aggression	9 (0.07)
Accidental Falls	6 (0.04)
Intestinal Infectious Diseases	3 (0.02)
Nutritional Deficiencies	2 (0.01)
Other accidental respiratory risks	2 (0.01)
Transport Accidents	1 (0.01)
Total avoidable deaths	10,497 (77.2)
2. OTHER CAUSES (NOT CLEARLY AVOIDABLE)	2,701 (19.86)
3. ILL-DEFINED CAUSES OF DEATH	403 (2.96)
Total deaths	13,601 (100)