Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil

Abstract

Objective: The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015. Methods: Population-based retrospective cohort of live births (LB) of single pregnancy with 0–27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately. Results: The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added. Conclusions: Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers – low education level and brown or black skin colors – were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.

Intrauterine growth restriction, prematurity, and low birth weight: risk phenotypes of neonatal death, Rio de Janeiro State, Brazil

“…Adolescence and low schooling were more related to fetal growth restriction in full-term infants, corroborating studies in other low- and middle-income countries 37 , 38 . Older maternal age emerged among preterm live births, according to a study in the city of Rio de Janeiro 19 . Black people and inadequate prenatal care were frequent in the extreme combination - preterm SGA - which was an expected result since both are corroborated factors for these conditions.…”

“…Eligible newborns had birth weight ≥ 500g, gestational age ≥ 22 weeks, and were children of single pregnancy. Records with values of inconsistent weight for gestational age, that is, values outside the consistent ranges of the lowest 3rd percentile value and the highest 97th percentile value 19 , and with reports of congenital anomalies (10th revision of the International Classification of Diseases - ICD-10 - code described in field 34 of the Declaration of Live Births), were excluded, due to their relationship with birth weight, growth restriction, and prematurity 9 .…”

“…Parity was evaluated according to the number of previous deliveries (zero: primiparous and ≥ 1: multiparous). The adequacy of access to prenatal care 19 was analyzed in a dichotomous way (no prenatal care and beginning of prenatal care ≥ 4th month or beginning of prenatal care ≤ 3rd month); as well as the mode of delivery (vaginal and cesarean section). Characteristics of the newborn were also evaluated: cephalic presentation at the time of delivery (yes and no), gender (female and male), and fifth minute Apgar score (< 7 and ≥ 7).…”

Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil

“…The analysis of previous pregnancies showed that 39.3% (5,191 The analysis of the adequacy of PNC in the RS and in the state's seven health macro-regions following the guidelines of the BMoH (Table 3) showed that, at the state level, 57.5% (n = 7,717, 95%CI: 56.3-58.6) started PNC up to the 12th of pregnancy and had at least six consultations. Also, according to BMoH criteria, the degree of inadequacy of PNC in the state reached 37.6% (n = 5,054, 95%CI: 36.8-38.5), being more expressive in the Metropolitan region (39.2%, n = 2,359, 95%CI: 37.9-40.4) and in the Sierra region (39.1%, n = 570, 95%CI: 36.6-41.6).…”

“…Maternal and infant mortalities are associated with the PNC inadequacy [3][4][5] . Therefore, a PNC with early onset and intervention for risk situations, as well as an agile hospital referral system, and the qualification of childbirth care, are the major health determinant indicators related to the mother and the newborn 3,4 .…”