Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Location and Period
2.2. Participants and Eligibility Criteria
2.3. Dependent Variable
2.4. Independent Variables
2.4.1. The Environmental Factors
2.4.2. The Maternal Factors
2.4.3. The Newborns’ Factors
2.4.4. Data Gathering
2.5. Statistical Analysis
2.6. Ethical Aspects
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable (n = 480) Distribution by Blocks | All n (%) | Death | p-Value * | RR | 95% CI | |
---|---|---|---|---|---|---|
Yes n (%) | No n (%) | |||||
Block 1—Maternal sociodemographic characteristics and environmental factors | ||||||
Age (years) a | 31.2 ± 5.70; 13–58 | 31.0 ± 5.99 | 31.2 ± 5.65 | 0.895 | 0.996 | 0.943–1.030 |
>35 | 105 (21.9) | 11 (28.2) | 94 (21.3) | 0.316 | 1.450 | 0.696–3.021 |
≤35 | 375 (78.1) | 28 (71.8) | 347 (78.7) | 1.000 | - | |
Marital status | ||||||
Single/without stable union | 117 (24.4) | 10 (25.6) | 107 (24.3) | 0.847 | 1.076 | 0.508–2.281 |
Married/stable union | 363 (75.6) | 29 (74.4) | 334 (75.7) | 1.000 | - | |
Education | ||||||
Elementary (I and II) | 19(4.0) | 0(0.0) | 19(4.3) | 0.566 | - | - |
Medium | 148(30.8) | 15(38.5) | 133(30.2) | - | - | |
Incomplete college | 70(14.6) | 5(12.8) | 65(14.7) | - | - | |
Complete college | 243(50.6) | 19(48.7) | 224(50.8) | - | - | |
Education: college—complete/incomplete | ||||||
YES | 313 (65.2) | 24 (61.5) | 289 (65.5) | 0.604 | 1.000 | - |
NO | 167 (34.8) | 15 (38.5) | 152 (34.5) | 1.171 | 0.632–2.171 | |
Potable water | ||||||
YES | 471 (98.1) | 38 (97.4) | 433 (98.2) | 0.537 | - | - |
NO | 9 (1.9) | 1 (2.6) | 8 (1.8) | - | - | |
Installed sewage system | ||||||
YES | 247 (51.5) | 19 (48.7) | 228 (51.7) | 0.741 | 1.000 | - |
NO | 233 (48.5) | 20 (51.3) | 213 (48.3) | 1.116 | 0.611–2.037 | |
Potable water + sewage system | ||||||
YES | 247 (51.5) | 19 (48.7) | 228 (51.7) | 0.741 | 1.000 | - |
NO | 233 (48.5) | 20 (51.3) | 213 (48.3) | 1.116 | 0.611–2.037 | |
Block 2—Pregnancy and associated comorbidities | ||||||
Prenatal consultation a | 6.8 ± 2.28;0–15 | 6.3 ± 2.33 | 6.9 ± 2.27 | 0.121 | 0.894 | 0.776–1.030 |
Pregnancy number a | 1.8 ± 1.06;1–8 | 1.9 ± 1.22 | 1.7 ± 1.05 | 0.448 | 1.105 | 0.854–1.429 |
1 | 261 (54.4) | 20 (51.3) | 241 (54.7) | 0.389 | 1.000 | - |
2 | 134 (27.9) | 9 (23.1) | 125 (28.3) | 0.876 | 0.410–1.872 | |
≥ 3 | 85 (17.7) | 10 (25.6) | 75 (17.0) | 1.535 | 0.748–3.150 | |
Parity a | 1.4 ± 0.69; 1–5 | 1.4 ± 0.68 | 1.4 ± 0.69 | 0.924 | 0.979 | 0.628–1.25 |
1 | 309 (64.4) | 25 (64.1) | 284 (64.4) | 0.927 | 1.375 | 0.341–5.556 |
2 | 137 (28.5) | 12 (30.8) | 125 (28.3) | 1.489 | 0.350–6.342 | |
≥ 3 | 34 (7.1) | 2 (5.1) | 32 (7.3) | 1.000 | - | |
Abortion history | ||||||
YES | 106 (22.1) | 14 (35.9) | 92 (20.9) | 0.042 | 1.976 | 1.062–3.664 |
NO | 374 (77.9) | 25 (64.1) | 349 (79.1) | 1.000 | - | |
Antenatal corticosteroids b (n = 362) | ||||||
YES | 149 (41.2) | 8 (34.8) | 141 (41.6) | 0.663 | 0.762 | 0.332–1.752 |
NO | 213 (58.8) | 15 (65.2) | 198 (58.4) | 1.000 | - | |
Presentation | ||||||
Cephalic | 57 (95.0) | 32 (82.1) | 388 (88.0) | 0.309 | 0.653 | 0.302–1.413 |
Pelvic/feet/breech | 3 (5.0) | 7 (17.9) | 53 (12.0) | 1.000 | - | |
Eclampsia | ||||||
YES | 8 (1.7) | 2 (5.1) | 6 (1.4) | 0.132 | 3.189 | 0.923–1.015 |
NO | 472 (98.3) | 37 (94.9) | 435 (98.6) | 1.000 | - | |
HELLP Syndrome | ||||||
YES | 13 (2.7) | 1 (2.6) | 12 (2.7) | 1.000 | 0.945 | 0.14–6.369 |
NO | 467 (97.3) | 38 (97.4) | 429 (97.3) | 1.000 | - | |
Preeclampsia/chronic high blood pressure | ||||||
YES | 110 (22.9) | 11 (28.2) | 99 (22.4) | 0.428 | 1.321 | 0.680–2.567 |
NO | 370 (77.1) | 28 (71.8) | 342 (77.6) | 1.000 | - | |
Hypertensive syndromes | ||||||
YES | 124 (25.8) | 13 (33.3) | 111 (25.2) | 0.258 | 1.435 | 0.762–2.705 |
NO | 356 (74.2) | 26 (66.7) | 330 (74.8) | 1.000 | - | |
Gestational diabetes | ||||||
YES | 38 (7.9) | 1 (2.6) | 37 (8.4) | 0.348 | 0.306 | 0.043–2.168 |
NO | 442 (92.1) | 38 (97.4) | 404 (91.6) | 1.000 | - | |
Third-trimester bleeding | ||||||
YES | 30 (6.2) | 5 (12.8) | 25 (5.7) | 0.085 | 2.206 | 0.931–5.228 |
NO | 450 (93.8) | 34 (87.2) | 416 (94.3) | 1.000 | - | |
Thrombophilia | ||||||
YES | 14 (2.9) | 0 (0.0) | 14 (3.2) | 0.617 | - | - |
NO | 466 (97.1) | 39 (100.0) | 427 (96.8) | - | - | |
Urinary tract infection | ||||||
YES | 86 (17.9) | 4 (10.3) | 82 (18.6) | 0.275 | 0.524 | 0.191–1.434 |
NO | 394 (82.1) | 35 (89.7) | 359 (81.4) | 1.000 | - | |
TORCHS c | ||||||
Present | 13 (2.7) | 1 (2.6) | 12 (2.7) | 1.000 | 0.945 | 0.14–6.369 |
Absent | 467 (97.3) | 38 (97.4) | 429 (97.3) | 1.000 | - | |
Complications in labor | ||||||
YES | 191 (39.8) | 23 (59.0) | 168 (38.1) | 0.016 | 2.175 | 1.180–4.008 |
NO | 289 (60.2) | 16 (41.0) | 273 (61.9) | 1.000 | - | |
Delivery type | ||||||
Cesarean | 414 (86.2) | 31 (79.5) | 383 (86.8) | 0.223 | 0.618 | 0.297–1.285 |
Vaginal | 66 (13.8) | 8 (20.5) | 58 (13.2) | 1.000 | - |
Variable (n = 480) Distribution by Blocks | All n (%) | Death | p-Value * | RR | 95% CI | |
---|---|---|---|---|---|---|
Yes n (%) | No n (%) | |||||
Block 3—Characteristics of the newborn | ||||||
Sex | ||||||
Male | 273 (56.9) | 25 (64.1) | 248 (56.2) | 0.401 | 1.354 | 0.722–2.539 |
Female | 207 (43.1) | 14 (35.9) | 193 (43.8) | 1.000 | - | |
Gestational age (weeks) a | 33.8 ± 3.93; 22–41 | 30.3 ± 5.97 | 34.1 ± 3.54 | <0.001 | 0.831 | 0.772–0.894 |
Premature | 369 (76.9) | 29 (74.4) | 340 (77.1) | 0.694 | 0.872 | 0.439–1.734 |
At term | 111 (23.1) | 10 (25.6) | 101 (22.9) | 1.000 | - | |
Birth weight (grams) a | 2220 ± 890; 360–5060 | 1610 ± 1120 | 2280 ± 850 | 0.001 | 0.427 | 0.259–0.704 |
Birth weight class (grams) <1500 | 109 (22.7) | 23 (59.0) | 86 (19.5) | <0.001 | 4.893 | 2.682–8.927 |
≥1500 | 371 (77.3) | 16 (41.0) | 355 (80.5) | 1.000 | - | |
Birth weight class (grams) <2500 | 289 (60.2) | 27 (69.2) | 262 (59.4) | 0.306 | 1.487 | 0.772–2.863 |
≥2500 | 191 (39.8) | 12 (30.8) | 179 (40.6) | 1.000 | - | |
Birth weight adequacy by GA b (WHO) c (n = 473) | ||||||
SGA d | 138 (29.2) | 15 (38.5) | 123 (28.3) | 0.199 | 1.580 | 0.802–3.113 |
AGA e/LGA f | 335 (70.8) | 24 (61.5) | 311 (71.7) | 1.000 | - | |
Apgar score, 1st minute a | 7.0 ± 2.08; 0–10 | 5.1 ± 2.77 | 7.2 ± 1.92 | <0.001 | 0.727 | 0.654–0.809 |
With anoxia (Apgar < 7) | 203 (42.3) | 28 (71.8) | 175 (39.7) | <0.001 | 8.599 | 4.192–7.637 |
No anoxia (Apgar 7–10) | 277 (57.7) | 11 (28.2) | 266 (60.3) | 1.000 | - | |
Apgar score, 5th minute a | 8.4 ± 1.2; 1–10 | 7.05 ± 2.03 | 8.52 ± 1.02 | <0.001 | 0.641 | 0.565–0.728 |
With anoxia (Apgar < 7) | 69 (14.4) | 19 (48.7) | 50 (11.3) | <0.001 | 5.659 | 3.188–10.044 |
No anoxia (Apgar 7–10) | 411 (85.6) | 20 (51.3) | 391 (88.7) | 1.000 | - | |
Block 4—Clinical complications of the newborn and therapeutic interventions | ||||||
Resuscitation | ||||||
YES | 173 (36.0) | 28 (71.8) | 145 (32.9) | <0.001 | 4.517 | 2.307–8.846 |
NO | 307 (64.0) | 11 (28.2) | 296 (67.1) | 1.000 | - | |
Perinatal asphyxia | ||||||
YES | 42 (8.8) | 14 (35.9) | 28 (6.3) | <0.001 | 5.840 | 3.294–10.353 |
NO | 438 (91.2) | 25 (64.1) | 413 (93.7) | 1.000 | - | |
Respiratory Distress Syndrome | ||||||
YES | 211 (44.0) | 27 (69.2) | 184 (41.7) | 0.001 | 2.868 | 1.489–5.526 |
NO | 269 (56.0) | 12 (30.8) | 257 (58.3 | 1.000 | - | |
Early neonatal sepsis | ||||||
YES | 212 (44.2) | 36 (92.3) | 176 (39.9) | <0.001 | 15.170 | 4.737–48.581 |
NO | 268 (55.8) | 3 (7.7) | 265 (60.1) | 1.000 | - | |
Late neonatal sepsis | ||||||
YES | 43 (9.0) | 5 (12.8) | 38(8.6) | 0.377 | 1.495 | 0.617–3.621 |
NO | 437 (91.0) | 34 (87.2) | 403 (91.4) | 1.000 | - | |
Oxygen (days) a,g (n = 452) | 9.7 ± 20.55; 1–159 | 12.4 ± 24.57 | 9.5 ± 20.15 | 0.418 | 1.005 | 0.993–1.018 |
YES | 452 (94.2) | 39 (100.0) | 413 (93.7) | 0.153 | - | - |
NO | 28 (5.8) | 0 (0.0) | 28 (6.3) | - | - | |
Mechanical ventilation (days) a,g (n = 154) | 9.0 ± 15; 1–102 | 10.3 ± 19.49 | 8.6 ± 13.42 | 0.607 | 1.005 | 0.986–1.024 |
YES | 154 (32.1) | 35 (89.7) | 119 (27.0) | <0.001 | 18.523 | 6.702–51.191 |
NO | 326 (67.9) | 4 (10.3) | 322 (73.0) | 1.000 | - | |
Parenteral nutrition (days) a,g (n = 129) | 9.3 ± 9.28; 1–70 | 10.0 ± 16.64 | 9.1 ± 6.33 | 0.676 | 1.008 | 0.972–1.045 |
YES | 129 (26.9) | 26 (66.7) | 103 (23.4) | <0.001 | 5.442 | 2.885–10.263 |
NO | 351 (73.1) | 13 (33.3) | 338 (76.6) | 1.000 | - | |
Venous umbilical catheter (days) a,g (n = 174) | 6.1 ± 3.83; 1–38 | 4.2 ± 3.89 | 6.6 ± 3.7 | <0.001 | 0.808 | |
YES | 174 (36.2) | 33 (84.6) | 141 (32.0) | <0.001 | 9.672 | 4.135–22.624 |
NO | 306 (63.8) | 6 (15.4) | 300 (68.0) | 1.000 | - | |
Peripherally inserted central catheter (days) a,g (n = 83) | 19.7 ± 15.72; 1–65 | 15.9 ± 14.61 | 20.2 ± 15.89 | 0.470 | 0.981 | 0.932–1.033 |
YES | 86 (17.9) | 10 (25.6) | 76 (17.2) | 0.194 | 1.580 | 0.800–3.118 |
NO | 394 (82.1) | 29 (74.4) | 365 (82.8) | 1.000 | - | |
Venous dissection | ||||||
YES | 6 (1.2) | 3 (7.7) | 3 (0.7) | 0.008 | 6.583 | 2.787–15.551 |
NO | 474 (98.8) | 36 (92.3) | 438 (99.3) | 1.000 | - | |
Hospitalization (days) a | 18.8 ± 24.77; 1–171 | 14.8 ± 24.5 | 19.1 ± 24.79 | 0.317 | 0.992 | 0.975–1.008 |
Analysis of Newborn Deaths | |||||||||
---|---|---|---|---|---|---|---|---|---|
Bivariate | Multivariate per Block | Final Multivariate | |||||||
Variables | p-Value * | RR | 95% CI | p-Value ** | RR | 95% CI | p-Value ** | RR | 95% CI |
Block 2—Pregnancy and associated comorbidities | |||||||||
Prenatal consultation | 0.121 | 0.894 | 0.776–1.030 | - | - | - | - | - | - |
Abortion history (YES) | 0.042 | 1.976 | 1.062–3.664 | 0.019 | 2.084 | 1.131–3.841 | 0.047 | 1.774 | 1.007–3.126 |
Antenatal corticosteroids a (YES) | 0.663 | 0.762 | 0.332–1.752 | - | - | - | - | - | - |
Eclampsia (YES) | 0.132 | 3.189 | 0.923–11.015 | - | - | - | - | - | - |
Third-trimester bleeding (YES) | 0.085 | 2.206 | 0.931–5.228 | - | - | - | - | - | - |
Complications in labor (YES) | 0.016 | 2.175 | 1.180–4.008 | 0.008 | 2.263 | 1.234–4.148 | - | - | - |
Block 3—Characteristics of the newborn | |||||||||
Gestational age (weeks) | <0.001 | 0.831 | 0.772–0.894 | 0.001 | 0.890 | 0.831–0.953 | - | - | - |
Birth weight (grams) <1500 | <0.001 | 4.893 | 2.682–8.927 | 0.024 | 1.924 | 1.091–3.394 | - | - | - |
Apgar score, 1st minute | <0.001 | 0.727 | 0.654–0.809 | <0.001 | 0.800 | 0.717–0.893 | - | - | - |
Apgar score, 5th minute: with anoxia (Apgar < 7) | <0.001 | 5.659 | 3.188–10.044 | - | - | - | - | - | - |
Block 4—Clinical complications of the newborn and therapeutic interventions | |||||||||
Resuscitation (YES) | <0.001 | 4.517 | 2.307–8.846 | - | - | - | - | - | - |
Perinatal asphyxia (YES) | <0.001 | 5.840 | 3.294–10.353 | 0.001 | 2.655 | 1.469–4.800 | 0.001 | 2.669 | 1.480–4.813 |
Respiratory Distress Syndrome (YES) | 0.001 | 2.868 | 1.489–5.526 | - | - | - | - | - | - |
Early neonatal sepsis (YES) | <0.001 | 15.170 | 4.737–48.581 | 0.005 | 6.841 | 1.789–26.164 | 0.004 | 6.843 | 1.824–25.675 |
Mechanical ventilation (YES) | <0.001 | 18.523 | 6.702–51.191 | - | - | - | - | - | - |
Parenteral nutrition (YES) | <0.001 | 5.442 | 2.885–10.263 | - | - | - | - | - | - |
Venous umbilical catheter (YES) | <0.001 | 9.672 | 4.135–22.624 | 0.018 | 3.359 | 1.227–9.196 | 0.021 | 3.275 | 1.199–8.948 |
Time of venous umbilical catheter (n = 174) | 0.001 | 0.808 | 0.711–0.919 | - | - | - | - | - | - |
Venous dissection (YES) | 0.033 | 6.583 | 2.353- 8.423 | - | - | - | - | - | - |
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Barreto, M.G.P.; Silva, C.; Barreto, R.P.; Barreto, R.P.; de Vasconcelos, L.M.T.; Manso, M.C. Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit. Healthcare 2024, 12, 1249. https://doi.org/10.3390/healthcare12131249
Barreto MGP, Silva C, Barreto RP, Barreto RP, de Vasconcelos LMT, Manso MC. Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit. Healthcare. 2024; 12(13):1249. https://doi.org/10.3390/healthcare12131249
Chicago/Turabian StyleBarreto, Maria Goretti Policarpo, Cláudia Silva, Renata Policarpo Barreto, Roberta Policarpo Barreto, Lara Moreira Teles de Vasconcelos, and Maria Conceição Manso. 2024. "Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit" Healthcare 12, no. 13: 1249. https://doi.org/10.3390/healthcare12131249