Fetal, neonatal, and post-neonatal mortality in the 2015 Pelotas (Brazil) birth cohort and associated factors.

Andrea Ramirez Varela,Susana Bubach,Diego G Bassani,Lina Sofia Moron Duarte,Marlos R Domingues,Ana Maria B Menezes,Mariangela Freitas Silveira,Bruna Celestino Schneider,Andréa Dâmaso Bertoldi

doi:10.1590/0102-311x00072918

Andrea Ramirez Varela, Susana Bubach + Show 7 more

Open Access

https://doi.org/10.1590/0102-311x00072918

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Abstract

This study aimed to describe fetal, neonatal, and post-neonatal mortality and associated factors in participants of the 2015 Pelotas (Brazil) birth cohort. The child mortality sub-study followed up all deaths in the first year of life. Data were collected on intrauterine fetal deaths (weight ≥ 500g and/or gestational age ≥ 20 weeks), neonatal deaths (< 28 days of life), and post-neonatal deaths (from 28 days to the end of the first year of life). Descriptive analyses using the Pearson chi-square test and a multinomial logistic regression to estimate the risk of fetal, neonatal, and post-neonatal deaths compared to live infants in the cohort (reference group) were performed. Data from 4,329 eligible births were collected, of which 54 died during the fetal period. Of the 4,275 eligible live births, 59 died in the first year of life. An association between fetal, neonatal, and post-neonatal deaths (OR = 15.60, 7.63, and 5.51 respectively) was found, as well as less than six prenatal consultations. Compared to live infants, fetal deaths were more likely to occur in non-white mothers, and neonatal deaths were 14.09 times more likely to occur in a preterm gestational age (< 37 weeks). Compared to live infants, infants that were born in a C-section delivery had 3.71 increased odds of post-neonatal death. Additionally, neonatal deaths were 102.37 times more likely to have a low Apgar score on the fifth minute after birth. These findings show the need for early interventions during pregnancy, ensuring access to adequate prenatal care.

Highlights

Worldwide infant mortality has declined over the past 25 years, but it still represents a public health priority, since, in 2016, 75% of all deaths in children under five occurred in the first year of life 1
In Brazil, in recent decades, there has been a reduction in infant mortality rates (IMR) from 53.4 per 1,000 live births in 1990 to about 13.5 per 1,000 live births in 2016 2
In 2012 a Brazilian study actively searched for infant deaths in 79 small and medium size municipalities in the North and Northeast of the country, and found that public health monitoring coverage was below 80% in seven states 10

Summary

Introduction

Worldwide infant mortality has declined over the past 25 years, but it still represents a public health priority, since, in 2016, 75% of all deaths in children under five occurred in the first year of life 1. In Brazil, in recent decades, there has been a reduction in infant mortality rates (IMR) from 53.4 per 1,000 live births in 1990 to about 13.5 per 1,000 live births in 2016 2 This decrease can be explained by the implementation of a series of policies, programs, and improvements in social, sanitary, and health conditions, such as poverty and fertility reduction, improvement in female education 3, urbanization expansion, Brazilian Income Transfer Program (2004), and the increased access to clean water and sanitation that started about 80 years ago [4,5]. This represents a mismatch when analysing regional sociodemographic patterns, as it is known that the South and Southeast regions do not have most of their population matching the cases that have been described as having low maternal education and black and brown skin colors 4

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