Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

Kale, Pauline Lorena; Mello-Jorge, Maria Helena Prado de; Silva, Kátia Silveira da; Fonseca, Sandra Costa

doi:10.1590/0102-311X00179115

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ARTICLE • Cad. Saúde Pública 33 (4) • 2017 • https://doi.org/10.1590/0102-311X00179115 copy

Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

Casos de near miss e óbitos neonatais: fatores associados aos recém-nascidos com ameaça à vida em seis maternidades do Sudeste do Brasil

Morbilidad near miss y mortalidad neonatal: factores asociados a condiciones involucrando riesgo de muerte en recién-nacidos en seis maternidades del Sureste do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births) and lack of prenatal care (80.8‰ live births). Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2), hemorrhage (OR = 2.2; 95%CI: 1.3-3.9), hypertension (OR = 3.0; 95%CI: 2.0-4.4), syphilis (OR = 3.3; 95%CI: 1.5-7.2), lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7), cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3), lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8) and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.

Keywords:
Infant Mortality; Low Birth Weight Infant; Premature Infant; Pregnancy Complications; Prenatal Care

Hierarchical level/Characteristics	Live births			Near miss rate			Mortality rate
Hierarchical level/Characteristics	n *	%	**	95%CI		**	95%CI
Sex
Male	3,631	51.0	17.6	13.8	22.4	4.4	2.7	7.1
Female	3,495	49.0	16.9	13.1	21.7	3.7	2.2	6.4
Distal
Maternal schooling (years)
< 8	1,362	19.7	18.4	12.5	26.9	2.9	1.1	7.5
≥ 8	5,559	80.3	17.3	14.2	21.0	4.3	2.9	6.4
Skin color
White	2,580	37,0	14.7	10.8	20.2	3.9	2.1	7.1
Brown	3,272	47,0	15.9	12.1	20.8	3.1	1.7	5.6
Black	936	13.4	27.8	19.0	40.4	7.5	3.6	15.4
Other	177	2.5	11.3	3.1	40.3	5.6	0.1	31.3
Intermediary
Maternal age (years)
< 20	1,593	22.4	13.8	9.1	20.8	3.1	1.3	7.3
20-34	4,910	68.9	17.1	13.8	21.1	4.3	2.8	6.5
≥ 35	623	8.7	27.3	17.1	43.3	4.8	1.6	14.1
Parity
Primiparous	3,005	42.2	19.6	15.2	25.2	3.3	1.8	6.1
Multiparous	4,114	57.8	15.6	12.2	19.8	4.6	3,0	7.2
Hemorrhage
Yes	398	5.6	35.2	21.1	5.8	15.1	6.9	32.5
No	6,728	94.4	16.2	13.5	19.5	3.4	2.3	5.1
High blood pressure
Yes	839	11.8	40.5	29.1	56.1	8.0	3.3	15.5
No	6,287	88.2	14.2	11.5	17.4	3.7	2.4	5.5
Syphilis
Yes	134	1.9	52.2	25.5	103.9	14.9	4.1	52.8
No	6,992	98.1	16.6	13.9	19.9	3.9	2.7	5.6
Smoking
Yes	1,024	14.4	21.5	14.2	32.3	4.9	2.1	1.1
No	6,090	85.6	16.6	13.7	20.1	3.9	2.7	5.9
Alcohol
Yes	959	13.5	20.9	13.5	32,0	7.3	3.5	15.0
No	6,156	86.5	16.7	13.8	20.3	3.6	2.4	5.4
Illegal drug use
Yes	94	1.3	31.9	10.9	89.7	21.3	5.8	74.3
No	7,021	98.7	17.1	14.3	20.4	3.8	2.6	5.6
Partner
Yes	4,603	85.3	15.0	11.9	18.9	3.9	2.5	6.2
No	2,451	34.7	21.6	16.6	28.2	4.5	2.5	8,0
Proximal
Prenatal care
Yes	7,010	98.6	16.4	13.7	19.7	3.3	2.2	4.9
No	99	1.4	80.8	41.5	151.4	50.5	21.8	112.8
Maternity/Hospital
A	543	7.6	25.8	15.4	42.8	20.3	11.3	35.9
B	1,190	16.7	26.1	18.4	36.7	1.7	0.1	6.1
C	1,528	21.4	19.6	13.8	27.9	5.2	2.7	10.3
D	734	10.3	10.9	5.5	21.4	2.7	0.1	9.9
E	1,522	21.4	19.7	13.8	28.0	3.3	1.4	7.7
F	1,609	22.6	6.2	3.4	11.4	0.6	0.1	3.5
Mode of delivery
Vaginal	4,811	67.5	11.8	9.2	15.3	3.7	2.4	5.9
Cesarean	2,315	32.5	28.5	22.4	36.1	4.8	2.7	8.5

Hierarchical level/Associated factors	Neonatal near miss			Neonatal mortality
	p-value	OR	95%CI	p-value	OR	95%CI
Male	0.81	1.05	0.73-1.49	0.65	1.19	0.57-2.47
Distal
< 8 years of schooling	0.79	1.06	0.68-1.66	0.48	0.68	0.24-1.96
Brown skin color	0.72	1.08	0.71-1.65	0.60	0.79	0.33-1.90
Black skin color	0.01	1.92	1.16-3.18	0.17	1.96	0.74-5.17
Other skin color/race	0.72	0.77	0.18-3.20	0.72	1.46	0.19-11.43
Intermediary
< 20 years old	0.37	0.80	0.50-1.29	0.53	0.73	0.28-1.94
≥ 35 years old	0.08	1.61	0.95-2.73	0.83	1.14	0.34-3.83
Primiparous	0.19	1.27	0.89-1.81	0.41	0.72	0.34-1.56
Hemorrhage	0.01	2.24	1.27-3.95	0.00	4.55	1.84-11.25
High blood pressure	0.00	2.95	1.98-4.41	0.13	2.02	0.82-4.97
Maternal syphilis	0.00	3.31	1.51-7.23	0.06	4.06	0.95-17.25
Smoking	0.27	1.30	0.82-2.08	0.66	1.25	0.47-3.27
Alcohol	0.36	1.26	0.77-2.04	0.10	2.06	0.88-4.83
Illegal drug use	0.27	1.93	0.60-6.19	0.02	5.72	1.34-24.43
Absence of partner	0.04	0.69	0.48-0.99	0.71	0.86	0.41-1.83
Proximal
Absence of prenatal care	0.00	5.56	2.63-11.74	0.00	17.37	6.45-46.76
Maternity hospital A	0.00	4.32	1.91-9.78	0.00	33.93	4.37-263.47
Maternity hospital B	0.00	4.28	2.09-8.77	0.41	2.76	0.25-30.50
Maternity hospital C	0.00	3.22	1.57-6.60	0.04	8.58	1.07-68.68
Maternity hospital D	0.23	1.77	0.69-4.49	0.23	4.41	0.40-48.76
Maternity hospital E	0.00	3.22	1.57-6.62	0.13	5.37	0.63-46.05
Cesarean section	0.00	2.45	1.71-3.50	0.50	1.29	0.61-2.74

Hierarchical level/Associated factors	Neonatal near miss				Neonatal mortality
Hierarchical level/Associated factors	p-value	OR	95%CI		p-value	OR	95%CI
Male	0.81	1.05	0.73	1.49	0.65	1.19	0.57	2.47
Distal
Black skin color	0.01	1.92	1.16	3.18	0.17	1.96	0.75	5.17
Intermediary
≥ 35 years old	0.04	1.76	1.01	3.08	0.77	1.20	0.34	4.20
Primiparous	0.01	1.74	1.16	2.62	0.93	0.96	0.40	2.28
Hemorrhage	0.01	2.20	1.24	3.91	0.01	3.63	1.35	9.75
High blood pressure	0.00	2.63	1.73	4.01	0.21	1.80	0.71	4.55
Maternal syphilis	0.01	2.90	1.30	6.48	0.13	3.14	0.71	13.82
Proximal
Absence of prenatal care	0.00	5.94	2.60	13.58	0.00	15.26	5.12	45.52
Maternity hospital A	0.02	2.73	1.17	6.36	0.00	22.85	2.79	187.07
Maternity hospital B	0.01	2.86	1.36	5.99	0.57	2.01	0.18	22.93
Maternity hospital C	0.01	2.83	1.36	5.89	0.07	7.30	0.89	60.28
Maternity hospital E	0.01	2.66	1.27	5.54	0.16	4.80	0.55	41.81
Cesarean section	0.00	2.00	1.35	2.96	0.91	0.91	0.39	2.14

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[1] * Correspondence P. L. Kale Instituto de Estudos de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Av. Brigadeiro Trompowsky s/n, Praça da Prefeitura Universitária, Rio de Janeiro, RJ 21949-900, Brasil. pkale@iesc.ufrj.br