Neonatal mortality: description and effect of hospital of birth after risk adjustment

Abstract

OBJECTIVE:To assess the effect of hospital of birth on neonatal mortality. METHODS:A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offi ces. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model. RESULTS:Neonatal mortality rate was 12.7‰ and it was highly infl uenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics. CONCLUSIONS:Neonatal mortality was high, mainly related to immaturity, and varied signifi cantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.

Mortalidade com 24 horas de vida de recém‐nascidos pré‐termo de muito baixo peso da Região Nordeste do Brasil

“…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 6. It is suggested that healthcare practices explain the differences in clinical outcome of newborns, particularly preterm neonates; however, it is difficult to identify the combination of practices considered potentially better to make an impact in reducing neonatal mortality 7.…”

“…Os cuidados hospitalares desempenham papel fundamental na variação de mortalidade encontrada entre os diversos centros. Tal fato se reveste de importância, uma vez que a maioria dos partos no Brasil ocorre em instituições de saúde 6. Sugere-se que as práticas assistenciais expliquem as diferenças encontradas no desfecho clínico dos recém-nascidos e, especialmente, dos neonatos pré-termo; no entanto, é difícil identificar a combinação de práticas consideradas potencialmente melhores para promover impacto na redução da mortalidade neonatal 7.…”

Características epidemiológicas e óbitos de prematuros atendidos em hospital de referência para gestante de alto risco

“…(2) The results of evaluation studies examining delivery and childbirth care and its influence on infant mortality indicate that in addition to population risk profile, the quality of hospital care is an important factor for the differences in mortality rates between hospitals in countries where most deliveries are institutionalized, such as in Brazil. (8,9) …”

Análise espacial da mortalidade perinatal no Vale do Paraíba - São Paulo - Brasil (2004-2008)

“…Esta observação está de acordo com vários autores, que destacam a prematuridade e o baixo peso ao nascer entre os principais fatores associados à mortalidade neonatal e infantil (Almeida & Barros, 2004;Carvalho et al, 2007;Paulucci & Nascimento, 2007;Barros et al, 2008;Jobim & Aerts, 2008). Santos et al No presente estudo observamos uma contribuição maior da variável gestante adulta, embora alguns estudos demonstrem a associação da gestação em adolescentes como fator de risco para baixo peso e óbito neonatal (Roth et al, 1998;Kilsztajn et al, 2003).…”

“…A maioria dos estudos sobre mortalidade perinatal e neonatal é do tipo analítico observacional, como estudos transversais, de coorte e de casocontrole, com utilização de regressão logística para identificação de fatores de risco associados ao óbito fetal (Matijasevich et al, 2005;Fonseca & Coutinho, 2010;Oliveira et al, 2010), neonatal (Sarinho et al, 2001;Araújo et al, 2007;Carvalho et al, 2007;Schoeps et al, 2007;Paulucci & Nascimento, 2007;Barros et al, 2008;) e perinatal (Barros et al, 1987;Aquino et al, 2007). Nesses tipos de estudo a unidade de observação é o indivíduo.…”