Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil<sup>,</sup>

Almeida, Maria Fernanda Branco de; Kawakami, Mandira Daripa; Moreira, Lícia Maria Oliveira; Santos, Rosa Maria Vaz dos; Anchieta, Lêni Márcia; Guinsburg, Ruth

doi:10.1016/j.jped.2016.11.008

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Original articles • J. Pediatr. (Rio J.) 93 (6) • Nov-Dec 2017 • https://doi.org/10.1016/j.jped.2016.11.008 copy

Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil^☆ ☆ Please cite this article as: Almeida MF, Kawakami MD, Moreira LM, Santos RM, Anchieta LM, Guinsburg R. Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil. J Pediatr (Rio J). 2017;93:576-84. ^,^☆☆ ☆☆ Study conducted at Sociedade Brasileira de Pediatria, Programa de Reanimação Neonatal, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing ≥2500 g in Brazil from 2005 to 2010.

Methods:

The population study enrolled all live births of infants with birth weight ≥2500 g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases,10th Revision (P20.0, P21.0, and P24.0). An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year.

Results:

A total of 10,675 infants weighing ≥2500 g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24 h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38%) of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (p < 0.001); the meconium aspiration syndrome-specific early neonatal mortality ratio remained between 0.20 and 0.29 per 1000 live births during the study period.

Conclusions:

Despite the decreasing rates in Brazil from 2005 to 2010, early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight and without congenital malformations are still high, and meconium aspiration syndrome plays a major role.

KEYWORDS
Asphyxia neonatorum; Early neonatal mortality; Meconium aspiration syndrome; Infant; Newborn; Brazil

	Missing data^a a Missing data: % of the 10,675 deaths without information.	2005 n = 2051	2006 n = 1822	2007 n = 1811	2008 n = 1790	2009 n = 1659	2010 n = 1542	X² for trend (p)
White mother	15%	45%	44%	39%	38%	38%	37%	<0.001
Mother <20 years old	9%	25%	25%	24%	23%	25%	24%	0.352
Mother <8 years of school	18%	64%	59%	63%	58%	58%	53%	<0.001
Housewife	33%	69%	57%	62%	57%	56%	62%	<0.001
First gestation	26%	50%	54%	49%	52%	51%	52%	0.413
Multiple gestation	2%	1.1%	1.2%	0.7%	0.8%	0.6%	0.8%	0.115
Cesarean section	2%	45%	46%	46%	48%	50%	49%	0.010
Gestational age 37-41 weeks	4%	82%	85%	84%	84%	85%	84%	0.251
Birth weight ≥4000 g	0%	8%	7%	8%	7%	8%	9%	0.522
Male	0%	58%	57%	56%	56%	57%	56%	0.300
Death in hospital	6%	97%	98%	97%	97%	97%	98%	0.933
Death in 1st hour after birth	8%	12%	11%	9%	11%	11%	13%	0.208
Death in the 1st 24 h after birth	0%	72%	70%	73%	72%	71%	71%	0.568
Death in public hospital	8%	72%	77%	74%	68%	69%	68%	<0.001
Death in a state capital	0%	26%	28%	23%	27%	24%	25%	0.066
Mother lives in the countryside but death in the capital	0%	12%	11%	11%	13%	12%	12%	0.235
Death in the city of maternal residence	0%	62%	59%	59%	57%	58%	56%	<0.001
Meconium aspiration syndrome	0%	34%	36%	38%	41%	40%	41%	<0.001

	Missing data^a a Missing data: % of the 4076 deaths without information.	2005 n = 698	2006 n = 650	2007 n = 689	2008 n = 741	2009 n = 661	2010 n = 637	X² for trend (p)
White mother	13%	46%	46%	43%	39%	42%	39%	0.002
Mother <20 years old	9%	23%	23%	23%	22%	24%	22%	0.867
Mother <8 years of school	19%	62%	59%	61%	58%	58%	52%	0.001
Housewife	34%	76%	62%	68%	60%	58%	63%	<0.001
First gestation	26%	51%	57%	49%	56%	55%	53%	0.465
Multiple gestation	2%	0.7%	0.9%	0.0%	0.5%	0.8%	0.5%	0.634
Cesarean section	2%	52%	49%	50%	51%	53%	51%	0.555
Gestational age 37-41 weeks	4%	84%	87%	87%	87%	87%	87%	0.206
Gestational age ≥42 weeks	4%	11%	8%	7%	7%	7%	7%	0.033
Birth weight ≥4000 g	0%	8%	7%	7%	5%	8%	9%	0.443
Male	0%	52%	51%	52%	51%	50%	51%	0.474
Death in hospital	6%	98%	98%	99%	97%	97%	99%	0.493
Death in 1st hour after birth	7%	7%	9%	6%	8%	8%	9%	0.506
Death in the 1st 24 h after birth	0%	73%	71%	74%	71%	72%	70%	0.404
Death in public hospital	8%	75%	79%	77%	71%	72%	70%	<0.001
Death in a state capital	0%	31%	35%	28%	32%	28%	28%	0.075
Mother lives in the countryside but death in the capital	0%	18%	15%	16%	19%	16%	16%	0.786
Death in the city of maternal residence	0%	62%	62%	61%	59%	58%	56%	0.003

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:ruthgbr@netpoint.com.br (R. Guinsburg).