The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004

Barros, Fernando C.; Victora, Cesar G; Barros, Aluísio J. D.; Santos, Iná S.; Albernaz, Elaine; Matijasevich, Alícia; Domingues, Marlos Rodrigues; Sclowitz, Iândora Krolow Timm; Hallal, Pedro Curi; Silveira, Mariângela Freitas da; Vaughan, J. G.

doi:10.1016/s0140-6736(05)71042-4

Cited by 251 publications

(255 citation statements)

References 22 publications

Supporting

Mentioning

177

Contrasting

Unclassified

Order By: Relevance

“…Also, the 'convenience' of its performance for the physician leads to the socalled 'iatrogenic' cesarean section. 21,22 Therefore, the high rates of cesarean section found in our study are similar to those reported for Brazil in 2003 for term (40%) and 32 to 36 weeks preterm infants (47%), 7 but much higher than the recommended rate by the World Health Organization: 23 'no region in the world is justified in having a cesarean section rate greater than 10 to 15 percent.' According to Young,24 factors identified that contribute to the increase in cesarean deliveries include provider practice, preferences and patterns; type of practitioners and staff patterns; and societal issues.…”

Section: Discussionsupporting

confidence: 86%

Resuscitative procedures at birth in late preterm infants

Almeida

Guinsburg

Costa³

et al. 2007

J Perinatol

View full text Add to dashboard Cite

Objective: Evaluate the need for resuscitative procedures at birth, in late prematures.Study Design: This prospective cohort study enrolled all liveborn infants from 1 to 30 September 2003, with 34 to 41 weeks of gestation without congenital anomalies, born in 35 public hospitals of 20 Brazilian state capitals. Logistic regression analyzed variables associated with the need for bag and mask ventilation.Result: Of the 10 774 infants studied, 1054 were late preterms and 485 required resuscitative measures. Of the 1054, 338 (32%) received only free-flow oxygen, 143 (14%) were bag and mask ventilated, 27 (3%) were intubated and 10/27 received chest compressions and/or medications. Bag and mask ventilation in late preterms was associated with twin gestation, maternal hypertension, nonvertex presentation, cesarean delivery and lower gestational age.Conclusion: Improving control of maternal hypertension, prolonging gestation for 1 to 2 weeks and restricting operative deliveries could decrease the need of resuscitation of late preterms at birth.

show abstract

Section: Discussionsupporting

confidence: 86%

Resuscitative procedures at birth in late preterm infants

Almeida

Guinsburg

Costa³

et al. 2007

J Perinatol

View full text Add to dashboard Cite

show abstract

“…23 Results of several studies conducted in developing and developed regions have found gestational age as a powerful predictor of neonatal mortality. 2,18 The univariate analysis of that study showed that preterm newborns had 2.32 risk of dying compared to term newborns. However, multivariable analyses showed this relationship was not significant regardless of birth weight and 5-min Apgar scores.…”

Section: Discussionmentioning

confidence: 95%

Neonatal mortality in intensive care units of Central Brazil

et al. 2005

View full text Add to dashboard Cite

ObjectiveTo identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. Methods A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatalbased mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. Results Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. Conclusions This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.

show abstract

“…A Brazilian cohort study [47] showed that the Brazil NMR did not change for two decades despite improvements in maternal and neonatal care and maternal health-seeking behaviour. They attributed the static NMR to an epidemiological and demographic transition the country was going through, with medicalisation of pregnancy and delivery, rapidly increasing the preterm births and deaths, which then offset the gains made in the better survival rate of term infants.…”

Section: Discussionmentioning

confidence: 99%