High risk pregnancies and factors associated with neonatal death

To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns.

METHOD

This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013.

RESULTS

Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death.

CONCLUSION

Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality.

Descriptors
Pregnancy, High-Risk; Infant mortality; Neonatal Nursing; Maternal-Child Nursing; Epidemiological Factors; Risk factors.

Variables	Neonatal Death
Variables	Yes^* * Unknown data was excluded		No^* * Unknown data was excluded
	n	%	n	%
Age					0.75
19 or younger	2	2.8	69	97.2
20-34	9	1.9	460	98.1
≥ 35	2	1.4	146	98.6
Years of schooling					0.39
8 or less	2	1.3	156	98.7
≥ 8	11	2.1	519	97.9
Race/Color					0.67
White (Caucasian)	9	2.1	415	97.9
Brown	4	1.7	228	98.3
Black	-	-	32	100.0
City of Residence					0.17
Maringá	8	2.6	301	97.4
Other locations	5	1.3	374	98.7
Marital status					0.59
Married	10	2.5	394	97.5
Divorced	0	0	11	100
Single	3	1.1	263	98.9
Windowed	-	-	5	100.0
Religion					0.37
Catholic	9	2.1	410	97.9
Other	4	1.5	265	98.5
Occupation					0.72
Paid	7	1.7	395	98.3
Unpaid	6	2.1	278	97.9

Variables	Neonatal Deaths
	Yes^* * Unknown data was excluded	No^* * Unknown data was excluded	Gross OR (CI 95%)	p	OR Adjusted (CI 95%)	p
	(n%)	n (%)	Gross OR (CI 95%)	p	OR Adjusted (CI 95%)	p
Gestational Age (weeks)
< 28	5 (55.6)	4 (44.4)	69.37 (54.00-203.39)	<0.001	682.47 (64.31-7241.65)	<0.001
28-31	4 (28.6)	10 (71.4)	22.00 (2.05-740.98)	<0.001	260.61 (25.24-2690.63)	<0.001
32-36	2 (1.8)	107 (98.2)	10.37 (0.73-29.41)	0.07	11.30 (1.01-127.07)	0.04
≥ 37	1 (0.2)	555 (99.8)	1.0
Parity
Primiparous	4 (2.1)	190 (97.9)	1.26 (0.32-4.66)	0.74
Multiparous	8 (1.6)	478 (98.4)	1.0
Type of Delivery
Cesarean	9 (1.8)	500 (98.2)	0.78 (0.22-3.06)	0.74
Normal	4 (2.2)	174 (97.8)	1.0
Type of Gestation
Single	10 (1.6)	632 (98.4)	1.0
Multiple	2 (4.7)	41 (95.3)	3.08 (0.01-15.73)	0.17	0.49 (0.04-5.28)	0.56
Gender
Female	5 (1.4)	344 (98.6)	0.77 (0.21-2.74)	0.66
Male	7 (1.8)	373 (98.2)	1.0
5-minute Apgar
< 7	7 (35.0)	13 (65.0)	75.82 (18.37-326.86)	<0.001	36.36 (5.35-247.13)	<0.001
≥ 7	5 (0.7)	704 (99.3)	1.0
Weight at birth (grams)
< 1500	9 (36.0)	16 (64.0)	34.13 (8.90-475.92)	< 0.001	217.73 (22.18-2137.08)	<0.001
1500-2499	2 (1.9)	105 (98.1)	11.31 (0.80-317.90)	0.06	7.46 (0.61-90.73)	0.11
≥ 2500	1 (0.2)	594 (99.8)	1.0

Risk stratification	Neonatal Death
	Yes^* * Unknown data was excluded.	No^* * Unknown data was excluded.	Gross OR	p	OR Adjusted (CI 95%)	p
	n (%)	(n%)	(CI 95%)	p	OR Adjusted (CI 95%)	p
Obstetrical history
Fetal and neonatal death	4 (7.4)	50 (92.6)	5.56 (1.38-20.69)	0.001	3.60 (0.93-13.89)	0.06
Low birth weight	3 (6,7)	42 (93.3)	4.52 (0.95-18.77)	0.04	1.74 (0.27-11.11)	0.55
Premature labor	3 (6.3)	45 (93.8)	6.22 (1.54-23.29)	0.01	3.58 (0.65-19.53)	0.13
Premature labor	3 (6.0)	47 (94.0)	4.01 (0.84-16.64)	0.06	0.85 (0.11-6.31)	0.87

Clinical incidents during the current gestation
Premature labor	3 (10.7)	25 (89.3)	7.80 (1.59-33.58)	0.01	11.43 (2.70-48.27)	< 0.001
Fetal malformation	2 (6.9)	27 (93.1)	4.36 (0.01-22.50)	0.10	7.92 (1.50-41.67)	0.01
Multiple gestations	3 (6.0)	47 (94.0)	4.01 (0.84-16.54)	0.06	6.01 (1.45-24.87)	0.01

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Marcela de Oliveira Demitto. Universidade Estadual de Maringá Av. Colombo, 5790. CEP 87020-900 - Maringá, Paraná, Brazil. mar_demitto@hotmail.com

Brasil

Brasil

High risk pregnancies and factors associated with neonatal death* * Extracted from the thesis "Gestantes de risco atendidas na Rede Mãe Paranaense: prematuridade e óbito neonatal", Programa de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, 2015.

Gestación de alto riesgo y factores asociados con la defunción neonatal

Abstract

OBJECTIVE

METHOD

RESULTS

CONCLUSION

High risk pregnancies and factors associated with neonatal death^* * Extracted from the thesis "Gestantes de risco atendidas na Rede Mãe Paranaense: prematuridade e óbito neonatal", Programa de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, 2015.