A positive association was found between mortality and this variable, with significantly declining values up to 2, g in weight. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. Perinatal mortality, which encompasses fetal deaths and early neonatal deaths, is an indicator of maternal-infant health, reflecting both the conditions of reproductive health, which are linked to socioeconomic factors, and the quality of perinatal care - prenatal, delivery, and neonatal 1. The clinical evaluation of the newborn NB was proposed by Virginia Apgar in and , and has been very useful in assessing the need for resuscitation of newborns, when applied at the 1 st minute of life, and again at 5 th minute 2. Since it is the only form of evaluation in developing countries, where laboratory tests may not be available, the low cost of the Apgar score is useful in identifying children who need additional care, even in the absence of laboratory data 3.
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The authors declare having no relationship with any person or organization that could improperly influence the study. To evaluate factors associated with neonatal death within 24 hours after birth in very low birth weight preterm newborns.
The 19 hospitals were assessed in relation to physical resources, equipment, human resources and aiming at quality in care initiatives. Hospital, maternal and neonatal characteristics, neonatal morbidity, neonatal procedures and interventions were compared between preterm newborns that died or survived up to 24 hours of life. The variables associated with death within 24 hours after birth were determined by logistic regression.
A better hospital structure was a protective factor for early neonatal death odds ratio: 0. The high neonatal mortality on the first day of life in capital cities of Northeast Brazil is associated with biological variables such as weight and gender of the newborn, as well as low vitality at birth and a worse infrastructure of the hospital where the birth occurred. Neonatal mortality has acquired increasing importance as the most significant cause of infant mortality.
The neonatal mortality rate remains high in Brazil; it was of live births in , which is 2. Actions aimed at improving such assistance have been recommended to reduce the early neonatal deaths.
In recent years, the prevalence of preterm births in Brazil is growing, first due to the increased use of assisted reproduction techniques, and second due to the quality of prenatal care and significant increase in the frequency of early terminations of pregnancy by surgical deliveries. In addition to the inequalities in the international and regional scenario, there are differences in neonatal mortality in different health institutions.
The causes of the differences are not clear, even after adjusting for patient characteristics. Hospital care plays a key role in mortality variation found between the various centers. This fact is of importance, as the majority of deliveries in Brazil take place in health institutions. In this context, the aim of this study was to evaluate factors associated with neonatal death in the first 24 h of very low birth weight preterm infants born in public hospitals of capital cities of Northeast Brazil.
Patients with major congenital malformations, transferred from other institutions, and those who died in the delivery room were excluded. In this study, we included only hospitals located in the capital cities Of those, two were excluded for not having maternity and eight for having less than 20 patients during the collection period. Therefore, 19 hospitals were included in nine capitals of the Brazilian Northeast. Data collection was performed prospectively in the chart of the newborn, from admission to discharge or death, by a field investigator trained by RENOSPE.
Data collected included hospital characteristics, maternal and neonatal demographics, and clinical evolution of the evaluated newborns.
The 19 maternity hospitals were evaluated using a questionnaire filled out by health professionals with respect to physical resources, equipment, human resources, and initiatives in search of quality of care, according to the previously published methodology, 9 and two categories were proposed: Level 1 L1 for the 13 hospitals with better infrastructure and Level 2 L2 for the six with less qualified infrastructure. Data of variables related to maternal demographic characteristics, complications during pregnancy, and use of antenatal corticosteroids were collect—considered present if at least one dose of corticosteroids was given before delivery—and type of delivery.
The primary outcome was death up to 24 h after birth. Statistical analysis initially compared the variables according to the presence or absence of outcome using the Mann—Whitney or t test for quantitative variables and chi-square or Fisher's exact test for qualitative variables. To identify factors associated with death within 24 h after birth, logistic regression was performed with the backward stepwise method. The final model adjustment was evaluated using the Hosmer—Lemeshow test. Statistical analysis was performed using SPSS Table 1 shows the distribution of maternal characteristics according to the occurrence of newborn death up to 24 h of life.
Table 2 shows the neonatal characteristics, interventions in the delivery room, and clinical complications in the first 24 h of life, according to the presence of death of the newborn in the first day of life.
Table 3 shows the variables related to procedures and interventions for neonatal care, according to survival or death on the first day of life. Table 4 shows the results of multivariate analysis for death on the first day of life. The logistic regression model was adjusted for the variables presence of prenatal care, cesarean delivery, and use of antenatal corticosteroids.
Model adjusted for the presence of prenatal care, cesarean delivery and use of antenatal corticosteroids. This multicenter study shows that neonatal mortality in the first 24 h of life is high in very low birth weight preterm infants in the capital cities of northeastern Brazil, compared with the more developed regions of Brazil and developed countries.
Of the studied neonates, 59 9. In the study of university public maternities in the South and Southeast performed by the Brazilian Neonatal Research Network in , of newborns evaluated, excluding deaths in the delivery room, 25 4.
It is noteworthy that patients weighing between and g were included in the study, which may have contributed to increase this percentage. The earlier the death of the newborn, the more it is related to the antenatal conditions, peripartum, and childbirth itself.
Death on the first day after birth is associated with social and economic determinants related to the quality of maternal health care. Among the factors associated with neonatal death on the first day of life there are three groups of variables: those related to the quality of perinatal care hospital category , those related to neonatal biological variables birth weight and male , and those reflecting care during labor and delivery Apgar score at 5 min.
Regarding hospital structure, all hospitals in the study belonged to the Unified Health System SUS and several authors reported high rates of neonatal mortality in SUS public hospitals. However, Alleman et al. It is noteworthy that, in the absence of a standardized evaluation model for hospital maternities associated with the risk of neonatal death, a weighted score of the characteristics related to hospital structure was established, in which the less frequent characteristics were most valued.
According to this score, it was seen that mortality on the first day of life of VLBW infants was two-fold higher in hospitals with poor infrastructure L2 , compared with those who with better conditions L1.
Among the studied characteristics, more sophisticated technological features, such as bedside ultrasound and echocardiography, and the potential to reflect on the medical practice used and learn from possible mistakes and omissions through clinical meetings were absent from most institutions classified as L2.
That is, although all hospitals analyzed were public and linked to SUS, some have invested more in diagnostic tools for premature patients, technology dependent for their survival, and some have invested more in the training of human resources, fundamental to apply the technological resources in this extremely vulnerable population of newborns. Regarding the biological factors related to neonatal death within 24 h after birth, we highlight the extremely low birth weight and male.
In the American Neonatal Network, among the extreme low birth weight preterm infants born between and , mortality was In the present study, in the VLBW infants between and g, mortality in the first 24 h was Mohamed et al. In the 18, newborns weighing between and g, mortality rate in the first day of life was Probably, the lower mortality rate in the weight range of —g at birth of the Northeastern maternities compared to the US reflects a large number of infants with intrauterine growth restriction and more advanced gestational age, which favors the chance of survival.
The male gender is strongly associated with death in the first 24 h of life, with a risk of death three times higher compared to women. The same finding was seen in-hospital mortality in other studies.
Australian research findings suggest that fetal growth and survival are mediated by sex-specific functions of human placenta, with better adaptation and response to oxidative stress in female.
In a population-based research in the United States performed between and , Lee et al. In Sweden, between and , the analysis of preterm infants with weeks gestational age also identified association between low Apgar scores at 5 min and neonatal mortality in the first 24h of life.
The risk was 7. Proper care during birth of preterm infants in the reference hospitals in the Northeastern city capitals is outlined as a priority to mitigate the transition difficulties for the extra-uterine life, facilitate the cardiorespiratory adaptation, and enable clinical stability and reduced mortality in the first day of life. It is important to emphasize that the use of secondary data has limitations and difficulties inherent in the methodology and favors failures in completing the forms.
Thus, eight hospitals were excluded from the study for presenting non-representative sample of its institutions. Furthermore, the interval of seven years between data collection and its analysis shows the difficulties for consolidating information in units where there is no training for research.
Nevertheless, this is the first study with prospective collection of reference maternities data in the Northeast region that helps outline a picture of the service to labor and delivery of very low birth weight preterm infants, which contribute significantly to neonatal children mortality and influence human development index of these places. In this context, the results indicate that early neonatal mortality especially in the first 24 h is high in very low birth weight preterm patients in the city capitals of the Northeast region compared to the more developed regions of Brazil and in developed countries.
Our findings reveal the existence of failures in the intensive care units assessed, with poor hospital infrastructure and high contribution of extremely low birth weight and perinatal asphyxia for mortality within the first 24 h of life. Overcoming these data requires a government policy that clearly assigns responsibilities for actions aimed at improving the quality, with priority settings, selection and definitions of interventions and constant evaluation.
The authors thank Dr. Ana Cecilia Sucupira and Prof. A pesquisa desenvolvida pela Renospe, com dados coletados das Unidades de Terapia Intensiva Neonatal, avaliou 36 hospitais nos estados do Nordeste.
O ajuste do modelo final foi avaliado pelo teste de Hosmer-Lemeshow. Entretanto, Alleman et al. Na rede americana Neonatal Network, dentre os 6. Nos O mesmo achado foi evidenciado na mortalidade intra-hospitalar em outros estudos. Estudo da Rede Americana de Pesquisas Neonatais, com dados de 9. National Center for Biotechnology Information , U. Journal List Rev Paul Pediatr v. Rev Paul Pediatr. Author information Article notes Copyright and License information Disclaimer.
Conflicts of interest A. Received Feb 27; Accepted May Published by Elsevier Editora Ltda. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.
Abstract Objective: To evaluate factors associated with neonatal death within 24 hours after birth in very low birth weight preterm newborns. Conclusions: The high neonatal mortality on the first day of life in capital cities of Northeast Brazil is associated with biological variables such as weight and gender of the newborn, as well as low vitality at birth and a worse infrastructure of the hospital where the birth occurred.
Introduction Neonatal mortality has acquired increasing importance as the most significant cause of infant mortality. Open in a separate window. Figure 1. Table 1 Maternal variables according to the presence of neonatal death 24 h after birth of very low birth weight preterm infants in the city capitals of the Northeast region.
Table 2 Neonatal characteristics according to the presence of death 24 h after the birth of low birth weight preterm infants in the city capitals of the Northeast region.
Table 3 Procedures and interventions for diagnostic and therapeutic neonatal care, according to the presence of neonatal death 24 h after the birth of very low birth weight preterm infants in the city capitals of the Northeast region.
Discussion This multicenter study shows that neonatal mortality in the first 24 h of life is high in very low birth weight preterm infants in the capital cities of northeastern Brazil, compared with the more developed regions of Brazil and developed countries. Acknowledgements The authors thank Dr.
References 1. Cad Saude Publica. Neonatal mortality: description and effect of hospital of birth after risk adjustment.
Mortality in the first 24h of very low birth weight preterm infants in the Northeast of Brazil
The authors declare having no relationship with any person or organization that could improperly influence the study. To evaluate factors associated with neonatal death within 24 hours after birth in very low birth weight preterm newborns. The 19 hospitals were assessed in relation to physical resources, equipment, human resources and aiming at quality in care initiatives. Hospital, maternal and neonatal characteristics, neonatal morbidity, neonatal procedures and interventions were compared between preterm newborns that died or survived up to 24 hours of life.
Estimating outcomes in newborn infants using fuzzy logic