Objective: neonatal mortality is the main cause of infant mortality in the city of Recife. The objective of the present study was to determine the major risk factors for neonatal death in Recife in 1995.Methods: this is a case control study. Information was obtained from the mortality and live birth databases after validation of the data set, between January and December 1995. A sample of 456 cases and 2,280 controls was obtained after using the linkage technique between the two data sets. The difference in proportion was analyzed by the chi square test. The odds ratio was calculated as a risk measure, with a 95% confidence interval. The logistic regression technique was used to adjust potential confounding factors.Results: 212 deaths (46.6%) occurred in the first 24 hours of life. We found that 358 (79.7%) of the cases presented low birth weight, with a 46-fold higher risk of death (CI =33.8-59.0 P<0.001) than those weighing > 2,500g. The major risk factors observed in the logistic regression analyses of the measure, listed in descending order, were: birth weight < 1,500g (OR= 49.6 CI= 22.6-108.7 P<0.001), 5-minute Apgar score < 7 (OR = 44.1 CI= 25.1-77.2 P<0.001), birth weight between 1,500 and 2,500g (OR= 8.2 CI= 4.8-14.0 P<0.001), gestational age < 37 weeks (OR= 4.3 CI= 2.6-7.1 P<0.001).Conclusions: among the studied variables, birth weight, gestational age, and Apgar score should be considered the main risk factors for the surveillance of neonatal death. Métodos: o desenho do estudo foi do tipo caso-controle. Realizou-se a validação dos bancos de dados do Sistema de Informação em Mortalidade e Sistema de Informação Nascido Vivo, para mães residentes no Recife, no ano de 1995. Obteve-se, após técnica do linkage entre os dois bancos de dados, amostra com 456 casos e 2.280 controles. Como medida de risco utilizou-se Odds Ratio, com intervalo de confiança de 95% e para a diferença de proporção, o teste qui quadrado. Utilizou-se na análise multivariada a técnica da regressão logística.Resultados: verificou-se que 358 (79,7%) das crianças que evoluíram para óbito foram de baixo peso ao nascer, com risco de morte 46 vezes superior (IC=33,8-59,0 P<0,001) para aquelas com este atributo em relação às nascidas com peso > 2.500g. Por ordem decrescente de valores da medida de associação de morte neonatal com as variáveis estudadas através da análise multivariada, os principais fatores de risco foram peso ao nascer < 1.500g (OR=49,6 IC=22,6-108,7 P<0,001), Índice de Apgar do quinto minuto < 7 (OR=44,1 IC=25,1-77,2 P<0,001), peso ao nascer entre 1.500g e 2.500g (OR=8,19 IC=4,(8)(9)(10)(11)(12)(13)(14)0 P<0,001), idade gestacional < 37 semanas (OR=4,3 IC=2,(6)(7)1 P<0,001).Conclusões: recomenda-se que entre as variáveis estudadas, estas três sejam consideradas fatores de risco importantes para vigilância da morte neonatal, em particular o baixo peso ao nascer.
The objective of this study was to show infant mortality differentials in different areas of Recife, analyzing the relationship between living conditions and mortality risk. An ecological study design compared infant mortality coefficients in 1995 with living conditions indicators obtained from the 1991 National Demographic Census. Information on the 770 infant deaths and 27,965 live births were collected from death and birth certificates. Information on water supply, sanitation, garbage collection, literacy, schooling, income, and overcrowding were used to establish a compound indicator for living conditions, constructed through factor analysis. The neighborhoods were then ordered according to the level of living conditions and grouped in 4 clusters, through hierarchical cluster analysis. Infant, neonatal, and post-neonatal mortality coefficients were 23.94, 17.66, and 6.28, respectively, for cluster I; and 32.04, 20.24, and 11.80 for cluster IV. In general, an inverse relationship was found between infant mortality and living conditions in clusters from Recife, revealing inequalities that are disguised when coefficients are expressed as averages for the entire city.
Objective: neonatal mortality is the main cause of infant mortality in the city of Recife. The objective of the present study was to determine the major risk factors for neonatal death in Recife in 1995.Methods: this is a case control study. Information was obtained from the mortality and live birth databases after validation of the data set, between January and December 1995. A sample of 456 cases and 2,280 controls was obtained after using the linkage technique between the two data sets. The difference in proportion was analyzed by the chi square test. The odds ratio was calculated as a risk measure, with a 95% confidence interval. The logistic regression technique was used to adjust potential confounding factors.Results: 212 deaths (46.6%) occurred in the first 24 hours of life. We found that 358 (79.7%) of the cases presented low birth weight, with a 46-fold higher risk of death (CI =33.8-59.0 P<0.001) than those weighing > 2,500g. The major risk factors observed in the logistic regression analyses of the measure, listed in descending order, were: birth weight < 1,500g (OR= 49.6 CI= 22.6-108.7 P<0.001), 5-minute Apgar score < 7 (OR = 44.1 CI= 25.1-77.2 P<0.001), birth weight between 1,500 and 2,500g (OR= 8.2 CI= 4.8-14.0 P<0.001), gestational age < 37 weeks (OR= 4.3 CI= 2.6-7.1 P<0.001).Conclusions: among the studied variables, birth weight, gestational age, and Apgar score should be considered the main risk factors for the surveillance of neonatal death. Métodos: o desenho do estudo foi do tipo caso-controle. Realizou-se a validação dos bancos de dados do Sistema de Informação em Mortalidade e Sistema de Informação Nascido Vivo, para mães residentes no Recife, no ano de 1995. Obteve-se, após técnica do linkage entre os dois bancos de dados, amostra com 456 casos e 2.280 controles. Como medida de risco utilizou-se Odds Ratio, com intervalo de confiança de 95% e para a diferença de proporção, o teste qui quadrado. Utilizou-se na análise multivariada a técnica da regressão logística.Resultados: verificou-se que 358 (79,7%) das crianças que evoluíram para óbito foram de baixo peso ao nascer, com risco de morte 46 vezes superior (IC=33,8-59,0 P<0,001) para aquelas com este atributo em relação às nascidas com peso > 2.500g. Por ordem decrescente de valores da medida de associação de morte neonatal com as variáveis estudadas através da análise multivariada, os principais fatores de risco foram peso ao nascer < 1.500g (OR=49,6 IC=22,6-108,7 P<0,001), Índice de Apgar do quinto minuto < 7 (OR=44,1 IC=25,1-77,2 P<0,001), peso ao nascer entre 1.500g e 2.500g (OR=8,19 IC=4,(8)(9)(10)(11)(12)(13)(14)0 P<0,001), idade gestacional < 37 semanas (OR=4,3 IC=2,(6)(7)1 P<0,001).Conclusões: recomenda-se que entre as variáveis estudadas, estas três sejam consideradas fatores de risco importantes para vigilância da morte neonatal, em particular o baixo peso ao nascer.
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