Factors associated with neonatal near miss in Brazil

Pereira, Theonas Gomes; Rocha, Daniele Marano da; Fonseca, Vânia Matos; Moreira, Maria Elisabeth Lopes; Gama, Silvana Granado Nogueira da

doi:10.11606/s1518-8787.2020054002382

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Brasil

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002382 copy

Factors associated with neonatal near miss in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil.

METHODS:

This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels.

RESULTS:

At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk – RR = 1.32; 95%CI 1.04–1.66), cesarean delivery (RR = 1.34; 95%CI 1.07–1.67), smoking (RR = 1.48; 95%CI 1.04–2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98–3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36–5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90–4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36–2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40–2.55) were associated with neonatal near miss.

CONCLUSIONS:

The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

DESCRIPTORS:
Near Miss; Healthcare; Pregnancy Complications; Risk Factors; Socioeconomic Factors; Maternal-Child Health Services

Variables		% Total	% NNM	RR	95%CI	p^a a P-value: Pearson's chi-square test.
Sex
	Male	51.7	4.1	1.15	0.98–1.35	0.078
	Female	48.3	3.5	1	–	–
Distal
	Region
	Southeast	42.6	4.3	1.38	0.99–1.92	0.057
	North	9.5	3.1	0.99	0.63–1.56	0.980
	Northeast	28.8	3.5	1.12	0.74–1.69	0.592
	South	12.5	3.1	1	–	–
	Central-West	6.6	4.1	1.31	0.86–2.01	0.204
Education
	Incomplete primary school	26.5	4.2	1.18	0.82–1.69	0.357
	Complete primary school	25.6	3.6	1.03	0.69–1.52	0.875
	Complete high school	38.9	3.7	1.04	0.68–1.59	0.837
	Complete higher education or above	8.9	3.5	1	–	–
Ethnicity/color
	White	33.8	3.3	1	–	–
	Black/brown/yellow/indigenous	66.2	4.1	1.24	0.98–1.56	0.075
Head of household
	No	89.6	3.9	1	–	–
	Yes	10.4	3.0	0.76	0.57–1.02	0.071
Economic class^b b According to Abep classification.
	Class D+E	23.6	3.8	1.14	0.89–1.47	0.303
	Class C	52.0	4.0	1.18	0.89–1.56	0.249
	Class A+B	24.3	3.4	1	–	–

Variables		% Total	% NNM	RR	95%CI	p^* * P-value: Pearson's chi-square test.
Sex
	Male	51.7	4.1	1.15	0.98–1.35	0.078
	Female	48.3	3.5	1	–	–
Intermediate
	Age (years)
	12 to 19	19.1	4.3	1.24	0.95–1.62	0.107
	20 to 34	70.5	3.4	1	–	–
	≥ 35	10.4	5.2	1.51	1.23–1.85	< 0.001
Marital Status
	Without partner	18.5	4.3	1.18	0.94–1.46	0.138
	With partner	81.5	3.7	1	–	–
Primiparous
	No	53.3	3.6	1	–	–
	Yes	46.7	4.0	1.12	0.94–1.35	0.207
Type of labor
	Vaginal birth	46.6	3.2	1	–	–
	Forceps	1.4	5.4	1.70	0.88–3.31	0.115
	Cesarean section	52.0	4.3	1.36	1.10–1.67	0.004
Regular use of tobacco
	No	92.8	3.7	1	–	–
	Yes	7.2	5.1	1.38	0.97–1.96	0.069
Gestational hypertensive syndromes
	No	89.0	3.2	1	–	–
	Yes	11.0	8.7	2.71	2.21–3.33	< 0.001
Syphilis
	No	99.0	3.8	1	–	–
	Yes	1.0	4.9	1.31	0.65–2.64	0.448
Pre-gestational diabetes
	No	99.0	3.7	1	–	–
	Yes	1.0	12.0	3.23	1.9–5.3	< 0.001
Gestational diabetes
	No	91.8	3.8	1	–	–
	Yes	8.2	4.4	1.18	0.92–1.52	0.197
Suspected misuse of alcohol
	There is no suspicion	3.9	4.3	1.16	0.66–2.03	0.609
	Suspected use	10.0	4.5	1.23	0.94–1.61	0.126
Did not drink alcohol		86.1	3.7	1	–	–
Gestation type
	Single	98.8	3.7	1	–	–
	Twin	1.2	11.8	3.18	2.25–4.50	< 0.001

Variables		% Total	% NNM	RR	95%CI	p^* * P-value: Pearson's chi-square test.
Sex
	Male	51.7	4.1	1.15	0.98–1.35	0.078
	Female	48.3	3.5	1	–	–
Proximal
Adequate prenatal care
	No	36.7	5.1	1.66	1.32–2.08	< 0.001
	Yes	63.3	3.1	1	–	–
Place of prenatal consultations
	Public	70.7	4.0	1.27	1.00–1.62	0.050
	Private	29.3	3.1	1	–	–
Hospital/maternity location
	Not in a capital city	63.4	2.8	1	–	–
	Capital city	36.6	5.5	1.95	1.44–2.65	< 0.001

Variables		Adjusted RR	95%CI	p^* * P-value: Pearson's chi-square test.
Sex of newborn
	Male	1.18	1.00–1.40	0.054
	Female	1	–	–
Distal
Ethnicity/color
	White	1	–	–
	Black/brown/yellow/indigenous	1.21	0.95–1.55	0.126
Intermediate
Age (years)
	12 to 19	1.28	0.98–1.67	0.073
	20 to 34	1	–	–
	≥ 35	1.32	1.04–1.66	0.020
Type of labor
	Vaginal birth	1	–	–
	Forceps	1.75	0.81–3.77	0.151
	Cesarean section	1.34	1.07–1.67	0.009
Regular use of tobacco
	No	1	–	–
	Yes	1.48	1.04–2.10	0.031
Gestational hypertensive syndromes
	No	1	–	–
	Yes	2.49	1.98–3.14	< 0.001
Pre-gestational diabetes
	No	1
	Yes	2.63	1.36–5.05	0.004
Gestation type
	Single	1	–	–
	Twin	2.98	1.90–4.68	< 0.001
Proximal
Adequate prenatal care
	No	1.71	1.36–2.16	< 0.001
	Yes	1	–	–
Hospital/maternity location
	Not in a capital city	1	–	–
	Capital city	1.89	1.40–2.55	< 0.001

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E-mail: revsp@usp.br

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[1] Correspondence: Theonas Gomes Pereira, Rua José Olímpio de Melo, 3426 64014-063 Teresina, PI, Brasil. E-mail: theonasgp@yahoo.com.br