Age-specific neonatal mortality and associated factors in the 2021 state of Rio de Janeiro (Brazil) birth cohort

Kale, Pauline Lorena; Fonseca, Sandra Costa

doi:10.1590/1980-549720220038

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 25 • 2022 • https://doi.org/10.1590/1980-549720220038 copy

Age-specific neonatal mortality and associated factors in the 2021 state of Rio de Janeiro (Brazil) birth cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the causes of age-specific neonatal deaths and death-associated factors in the 2021 state of Rio de Janeiro birth cohort.

Methods:

Retrospective cohort of live births (LB) followed up to 27 days of delivery (<24hs, 1–6 and 7–27 days). Data obtained from the Information Systems on Live Births (2021) and Mortality (2021/2022). We described the distributions of maternal and newborn characteristics and causes of death. We used multinomial regression models with hierarchical levels of determination of neonatal death.

Results:

Of the 179,837 LB, 274 died within 24 hours, 447 within 1-6 days and 324 within 7-27 days. The neonatal mortality rate was 5.8‰ LB (CI 95%: 5.5–6.2). Neonatal survivors and deaths were heterogeneous according to the analyzed characteristics, except for the reproductive history (p<0,05). 78% of causes of death were avoidable. Causes reducible by adequate care for pregnant women (<24 hours and 1-6 days) and newborns (7-27 days) predominated. Low schooling showed a significant association for deaths between 7-27 days (OR_ajusted=1.3); mixed race, for deaths between 1-6 days (OR_ajusted=1.3), and black color for both age groups (1-6 days: OR_ajusted=1.5 and 7-27 days: OR_ajusted=1.8). Health care and biological factors of LB (intermediate and proximal levels) remained strongly associated with neonatal death, regardless of age.

Conclusion:

Causes of death, factors associated with neonatal death, and strength of association differed according to death-specific age. Preventive actions for neonatal death should consider sociodemographic vulnerabilities and intensify adequate prenatal and perinatal care.

Keywords:
Birth cohort; Neonatal mortality; Early neonatal mortality; Cause of death; Sociodemographic factors; Prenatal care

Characteristics		Neonatal survivors		Neonatal deaths						p
		Neonatal survivors		<24 hours		1–6 days		7–27 days
		n	%	n	%	n	%	n	%
Age range (years)
	<20	22,181	12.4	42	15.3	67	15.0	56	17.3	0.002
	20–34	125,283	70.1	178	65.0	293	65.6	198	61.1
	≥35	31,328	17.5	54	19.7	87	19.5	70	21.6
Education (years)
	0–3	1,919	1.1	3	1.2	4	0.9	6	1.9	0.035
	4–11	133,881	76.6	215	82.1	366	83.2	261	83.1
	≥12	38,908	22.3	44	16.8	70	15.9	47	15.0
Race/color
	White	56,777	32.7	73	28.6	115	26.4	82	26.1	<0.001
	Black	25,371	14.6	42	16.5	77	17.7	67	21.3
	Brown	91,362	52.7	140	54.9	244	56.0	165	52.6
Deceased children/miscarriages
	None	139,222	99.6	201	100.0	337	98.8	229	100	0.163
	≥1	538	0.4	0	0.0	4	1.2	0	0.0	0.163
Alive children
	None	75,866	43.2	120	44.4	197	44.2	155	48.3	0.103
	1–3	92,968	52.9	136	50.4	228	51.1	147	45.8
	≥4	6,949	4.0	14	5.2	21	4.7	19	5.9
Previous births
	0	74,765	42.5	115	42.6	192	43.1	148	46.3	0.591
	≥1	101,214	57.5	155	57.4	254	57.0	172	53.8	0.591
Inadequate prenatal care
	Yes	38,427	21.8	88	33.1	127	28.7	97	30.5	<0.001
	No	137,502	78.2	178	66.9	316	71.3	221	69.5	<0.001
Cephalic presentation
	Yes	170,983	97.2	207	79.3	376	85.1	281	88.4	<0.001
	No	4,980	2.8	54	20.7	66	14.9	37	11.6	<0.001
Type of delivery
	Vaginal	75,940	42.5	143	52.6	184	41.2	165	50.9	<0.001
	Caesarean	102,738	57.5	129	47.4	263	58.8	159	49.1	<0.001
Gender
	Female	87,532	49.0	124	45.6	176	39.4	145	44.9	<0.001
	Male	91,244	51.0	148	54.4	271	60.6	178	55.1	<0.001
Weight (grams)
	500 to 1,499	1,400	0.8	152	55.5	249	55.7	148	45.7	<0.001
	1,500 to 2,499	10,317	5.8	60	21.9	67	15.0	66	20.4
	2,500 to 3,999	158,733	88.8	60	21.9	121	27.1	108	33.3
	≥4,000	8,342	4.7	2	0.7	10	2.2	2	0.6
Gestational age (weeks)
	23–31	1,456	0.8	145	55.8	241	54.9	141	44.8	<0.001
	32–36	14,667	8.4	67	25.8	86	19.6	77	24.4
	≥37	159,403	90.8	48	18.5	112	25.5	97	30.8
Apgar 5^th minute
	<7	1,259	0.7	208	80.0	144	33.4	1.689	1.0	<0.001
	≥7	175,875	99.3	52	20.0	287	66.6	176.448	99.1	<0.001

Avoidability group (LBE)^* * LBE: Brazilian List of Avoidable Causes of Death (Lista Brasileira de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil); and main cause (ICD)^† † ICD: International Classification of Diseases		<24 hours (n=274)		1–6 days (n=447)		7–27 days (n=324)		Total (n=1,045)
		n	%	n	%	n	%	n	%
1) Avoidable		185	67.5	359	80.3	229	70.7	773	74.0
	Reducible by adequate care during pregnancy	90	32.9	168	37.6	65	20.1	323	30.9
	• Maternal disorders (P00)	26		63		26		115
	Reducible by adequate delivery care	56	20.4	78	17.5	34	10.5	168	16.1
	• Intrauterine Hypoxia and Asphyxia (P20, P21)	30		37		19		86
	Reducible by adequate newborn care	39	14.2	111	24.8	122	37.7	272	26.0
	• Specific perinatal infections (P35 to P39.9)	17		71		65		153
	Reducible by proper diagnosis and treatment	-	-	1	0.2	5	1.5	6	0.6
	Reducible by adequate health promotion	-	-	1	0.2	3	0.9	4	0.4
2) Poorly defined		2	0.7	5	1.1	3	0.9	10	1.0
3) Other causes		87	31.8	83	18.6	92	28.4	262	25.1

Hierarchical level and Variables		<4 hours				1–6 days				7–27 days
Hierarchical level and Variables		p-value	OR^* * OR: odds ratio;	95%CI^† † 95%CI: 95% confidence interval; numbers in bold highlight the categories of variables that are factors associated with each specific age of death, considering the level of statistical significance (p-value).		p-value	OR^* * OR: odds ratio;	95%CI^† † 95%CI: 95% confidence interval; numbers in bold highlight the categories of variables that are factors associated with each specific age of death, considering the level of statistical significance (p-value).		p-value	OR^* * OR: odds ratio;	95%CI^† † 95%CI: 95% confidence interval; numbers in bold highlight the categories of variables that are factors associated with each specific age of death, considering the level of statistical significance (p-value).
Male		0.266	1.1	0.9	1.5	<0.001	1.5	1.2	1.8	0.144	1.2	0.9	1.5
Distal
	<8 years of study	0.239	1.2	0.9	1.7	0.134	0.9	1.0	1.6	0.048	1.3	1.0	1.8
	Brown color	0.224	1.2	0.9	1.6	0.026	1.3	1.0	1.6	0.263	1.2	0.9	1.5
	Black color	0.217	1.3	0.9	1.9	0.009	1.5	1.1	2.0	0.001	1.8	1.3	2.5
Intermediate I
	<20 years	0.178	1.3	0.9	1.8	0.175	1.2	0.9	1.6	0.013	1.5	1.1	2.0
	≥35 years	0.137	1.3	0.9	1.8	0.093	1.2	1.0	1.6	0.008	1.5	1.1	2.0
Intermediate II
	Inadequate prenatal care	<0.001	6.3	4.7	8.5	<0.001	4.5	3.7	5.6	<0.001	4.0	3.1	5.2
	Non-cephalic fetal presentation	<0.001	9.0	6.4	12.7	<0.001	6.4	4.9	8.5	<0.001	4.6	3.2	6.8
Proximal
	<1,500g	<0.001	6.1	2.5	14.6	<0.001	13.1	7.2	23.8	<0.001	13.8	6.9	27.2
	1,500–2,499g	0.003	2.8	1.4	5.4	<0.001	2.5	1.6	4.0	<0.001	3.4	2.1	5.6
	≥4,000g	0.947	1.0	0.2	4.0	0.054	1.9	1.0	3.7	0.309	0.5	0.1	2.0
	23–32 weeks	<0.001	7.6	3.1	18.7	<0.001	10.6	5.7	19.7	<0.001	7.9	3.9	15.8
	32–36 weeks	0.002	2.8	1.5	5.5	<0.001	3.6	2.4	5.6	<0.001	3.1	1.9	5.0
	Apgar 5’<7	<0.001	151.4	101.8	225.2	<0.001	13.7	10.4	18.2	<0.001	8.9	6.3	12.7

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[1] CORRESPONDING AUTHOR: Pauline Lorena Kale. Avenida Horácio Macedo, s/n, Cidade Universitária, CEP: 21941-598, Rio de Janeiro (RJ), Brasil. E-mail: pkale@iesc.ufrj.br