Abstract
BackgroundIn Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period. Therefore, this study aims at assessing perinatal factors associated with early neonatal deaths in very low birth weight preterm infants born in a region of Brazil with low Human Development Index.MethodsProspective cohort study of inborns with gestational age 230/7-316/7 weeks and birthweight 500-1499 g without malformations in 19 public reference hospitals of the state capitals of Brazil’s Northeast Region. Perinatal variables associated with early neonatal death were determined by Cox regression analysis.ResultAmong 627 neonates, 179 (29%) died with 0–6 days after birth. Early death was associated to: absence of antenatal steroids (HR 1.59; 95% CI 1.11-2.27), multiple gestation (1.95; 1.28-3.00), male sex (2.01; 1.40-2.86), 5th minute Apgar <7 (2.93; 2.03-4.21), birthweight <1000 g (2.58; 1.70-3.88), gestational age <28 weeks (2.07; 1.42-3.02), use of surfactant (1.65; 1.04-2.59), and non-use of a pain scale (1.89; 1.24-2.89).ConclusionBiological variables and factors related to the quality of perinatal care were associated with the high chance of early death of preterm infants born in reference hospitals of Northeast Brazil.
Highlights
In Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period
Biological variables and factors related to the quality of perinatal care were associated with the high chance of early death of preterm infants born in reference hospitals of Northeast Brazil
Between July and December 2007, a total of 27,991 live births occurred in the 19 public reference hospitals in the capitals of the Northeast region included in the study
Summary
In Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period. This study aims at assessing perinatal factors associated with early neonatal deaths in very low birth weight preterm infants born in a region of Brazil with low Human Development Index. Three quarters occur in the first week of life [1]. In Brazil, the neonatal mortality rate remains high, at 10 out of every 1,000 live births in 2011, and accounts for 70% of infant mortality. Post-neonatal components of infant mortality were largely reduced throughout the country due to improvements in primary health care, but neonatal deaths in the first week of life have increased from 50% of infant deaths in 2000 to 53% in 2010, and. In the Northeast region of Brail, the early neonatal mortality rate (11.6/1,000 live births) is twice as high as that of the South (5.9/1,000 live births). Mortality during the first day of life is becoming an increasingly large contributor to the overall infant mortality rate in the Northeast, rising from 23% in 2000 to 28% in 2010, while the opposite trend was observed in the Southeast, where mortality in the first day of life was reduced from 27% in 2000 to 24% in 2010 [2]
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