Factors associated with neonatal death among adolescent mothers

randomized hospital-based cross-sectional study in a tertiary institution,, data from the Sistema de Informação sobre Nascidos Vivos (Sinasc), (Live Birth Information System), Sistema de Informação sobre Mortalidade (SIM) (Mortality Information System), and medical records. The study population was comprised of 1,341 adolescents aged 10-19 who had assisted childbirth at the institution between 2012 to 2016. The independent variables were sociodemographic characteristics, care, prenatal, childbirth, birth, and newborn’s hospitalization, as well as the baby’s characteristics. Logistic regression analysis was carried out to assess the association between neonatal death and explanatory variables.

Results:

the factors associated with death were from the countryside or other States (OR=2.68; CI95% =1.24-5.81), Apgar scores lower than 7 in the 1st (OR= 9.52; CI95% = 4.15-21.81) and the 5th (OR=4.17; CI95%=1.53-11.34) minutes of life; and birth weight less than 999g (OR=13.37; CI95% =3, 64-49.04) and between 1,500 to 2,499g (OR=3.43; CI95%=1.37-8.58).

Conclusions:

apgar and low birth weight were associated with the neonatal death among adolescent mothers, as well as the fact they come from the countryside and other States. These findings show, in addition to classic risks, potential difficulties for adolescents in having access to healthcare services in their hometown. To reduce the risks, there is a need for restructuring the maternal and child healthcare network and ensure a social protection network for these girls.

Key words
Neonatal mortality; Teenage pregnancy; Adolescent; Pregnancy; Neonatal death

Indicators	N	n	%	CI95%	p
Maternal age (years)					0.338
10-14	96	2	2.1	(0.25 - 7.7)
15-19	1,335	54	4.0	(3.0 - 5.3)
Race/Skin Color					0.385
White	243	7	2.9	(1.2 - 5.8)
Black	134	5	3.7	(1.2 - 8.5)
Yellow	8	1	12.5	(3.2 - 52.7)
Mixed	997	39	3.9	(2.8 - 5.3)
Indigenous	8	0	0.0	-
Schooling in years					0.317
≥ 8	879	30	3.4	(2.3 - 4.8)
< 8	538	24	4.5	(2.9 - 6.6)
Occupation					0.335
Student	453	21	4.6	(2.9 - 7.0)
Paying job	96	4	4.2	(1.1 - 10.3)
Unpaid job and dropout	845	30	3.6	(2.4 - 5.0)
Marital status					0.304
Living with a partner	422	20	4.7	(2.9 - 7.2)
Without partner	1,005	36	3.6	(2.5 - 4.9)
City of Origin					<0.001
Metropolitan region	1,144	32	2.8	(1.9 - 3.9)
Countryside or from other States	287	24	8.4	(5.4- 12.2)
Number of prenatal consultations					0.047
≥ 7	524	13	2.5	(1.3 - 4.2)
> 7 Which trimester began prenatal care	897	41	4.6	(3.3 - 6.2)
First	784	23	2.9	(1.9 - 4.4)
Second	489	21	4.3	(2.7 - 6.5)	0.100
Third	68	4	5.9	(1.6 - 14.4)
Obstetric history					0.919
First pregnancy	1,062	42	4.0	(2.9 - 5.3)
Recurrent pregnancy	365	14	3.8	(2.1 - 6.4)

Indicators	N	n	%	CI95%	p
Access to healthcare service					0.630
Spontaneous demand	797	28	3.5	(2.3 - 5.0)
Referral	599	24	4.0	(2.6 - 5.9)
Adequacy of risk rating to waiting time					0.065
Adequate	787	39	4.9	(3.5 - 6.7)
Inadequate	588	17	2.8	(1.6 - 4.5)
Hospitalization reason					0.777
Follow-up of natural birth	1,363	52	3.8	(2.9- 5.0)
Indication for cesarean section	38	2	5.3	(0.6 - 17.8)
Clinical treatment that progressed to childbirth	14	00	0.0	-
Existence of previous isolated or associated morbidity					0.016
No	704	35	5.0	(3.5 - 6.9)
Yes	711	18	2.5	(1.5 - 4.0)
Results of serologies for AIDS, hepatitis B and syphilis at hospitalization					0.650
Negative	1,348	53	3.9	(3.0 - 5.1)
Positive	70	2	2.9	(0.4 - 9.9)
Use of corticosteroids in case of prematurity					0.089
Yes	101	7	6.9	(2.9 - 13.8)
No	1,317	47	3.6	(2.6 - 4.7)
Use of antibiotics before childbirth					0.890
No	1,273	49	3.8	(2.9- 5.1)
Yes, prophylactic and in case of treatment	147	6	4.1	(1.5 - 8.7)
Labor Induction					0.112
No	1,081	47	4.3	(3.2 - 5.7)
Yes	331	8	2.4	(1.1 - 4.7)
Use of partograph					0.004
Yes	423	7	1.7	(0.07 - 3.4)
No	974	48	4.9	(3.7 - 6.5)
Maternal assessment interval in minutes					0.056
< 60	333	7	2.1	(0.9 - 4.3)
> 60	1,089	48	4.4	(3.3 - 5.8)
Fetal assessment interval in minutes					0.058
< 60	332	7	2,1	(0.9 - 4.3)
> 60	1,090	48	4.4	(3.3 - 5.8)
Type of childbirth					0.829
Normal	1,015	39	3.8	(2.8 - 5.2)
Cesarean section	416	17	4.1	(2.4 - 6.5)

Indicators	N	n	%	CI95%	p
Day of birth					0. 599
Monday to Friday	950	39	4.1	(3.0 -5.6)
Weekend	481	17	3.5	(2.1 - 5.6)
Shift on duty at birth time					0.115
Daytime	735	23	3.1	(2.0 - 4.7)
Night time	695	33	4.7	(3.3 - 6.6)
Gestational age (weeks)					<0.001
37 - 41.6	1,022	19	1.9	(1.1 - 2.9)
< 37	389	37	9.5	(6.8 - 12.9)
≥ 42	18	00	0.0	-
Sex					0.407
Female	691	24	3.5	(2.2 - 5.2)
Male	740	32	4.3	(3.0 - 6.6)
Apgar score / 1st minute					<0.001
7 - 10	1,224	15	1.2	(0.7 - 2.0)
< 7	203	41	20.2	(15.00 - 26.4)
Apgar score / 5th minute					<0.001
7-10	1,373	32	2.3	(1.6 - 3.3)
< 7	55	24	43.6	(30.3 -57.7)
Birth weight (g)					<0.001
2,500 - 4,000	1,063	15	1.4	(0.07 - 2.3)
1,500 - 2,499	265	19	7.1	(4.3 - 10.9)
1,000 - 1,499	31	5	16.1	(5.4 - 33.7)
Up to 999	16	17	94.1	(71.3 - 99.8)

Variable	Not adjusted			Adjusted
Variable	OR	CI95%	p	OR	CI95%	p
City of origin			<0.001			0.012
Metropolitan region	1			1
Countryside or from other States	3.17	1.83 - 5.47		2.68	1.24 - 5.81
Number of prenatal consultations						0.902
≥ 7	1			1
< 7 Which trimester began prenatal care	1.88	0.99 - 3.54	0.047	0.94	0.36 - 2.40
First	1			1
Second	1.48	0.81 - 2.71	0.199	2.05	0.91 - 4.61	0.083
Third	2.07	0.69 - 6.16	0.192	2.42	0.53 - 10.91	0.249
Adequacy of risk rating to waiting time						0.263
Adequate	1			1
Inadequate	0.58	0.32 - 1.04	0.065	0.63	0.29 - 1.40
Existence of previous isolated or associated morbidity						0.319
No	1			1
Yes	0.49	0.27 - 0.88	0.016	0.67	0.31 - 1.45
Labor Induction						0.924
No	1			1
Yes	0.54	0.25 - 1.16	0.112	0.95	0.36 - 2.51
Use of partograph						0.326
Yes	1			1
No	3.08	1.38 - 6.86	0.004	2.48	0.40 - 15.26
Maternal assessment interval (min)						0.901
≤60	1			1
>60	2.14	0.96 - 4.79	0.056	2.27	0.00 - 946856.34
Fetal assessment interval (min)						0.916
≤60	1			1
>60	2.13	0.95 - 4.77	0.058	0.50	0.00 - 198803.39
Shift on duty at birth time						0.963
Daytime	1			1
Night time	1.54	0.89 - 2.65	0.115	1.01	0.48 - 2.16
Gestational age (weeks)						0.196
37 - 41.6	1			1
< 37	5.54	3.15 - 9.77	<0.001	1.75	0.74 - 4.08
Apgar score / 1st minute						<0.001
7 - 10	1			1
<7	20.39	11.04 - 37.68	<0.001	9.52	4.15 - 21.81
Apgar score / 5th minute						0.005
7 - 10	1			1
<7 Birth weight (g)	32.44	17.14 - 61.39	<0.001	4.17	1.53 - 11.34
2,500 - 4,000	1			1
1,500 - 2,499	4.92	2.46 - 9.81	<0.001	3.43	1.37 - 8.58	0.008
1,000 - 1,499	11.07	3.78 - 32.39	<0.001	3.30	0.82 - 13.31	0.093
Up to 999	72.95	31.12 - 171.03	<0.001	13.37	3.64 - 49.04	<0.001

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[1] Authors’ contribution

Araujo VMG, Silva JS, Bezerra Silva CL, Costa MSO: Research, Methodology, Writing, Revision and Editing; Costa EC, Frias PG, Barros MVG and Correia Junior MAV: Conceptualization, formal analysis, investigation, methodology, supervision, writing, original draft, writing, reviewing and editing. All authors approved the final version of the article.