Schoeps Daniela, Furquim de Almeida Marcia, Alencar Gizelton Pereira, França Ivan, Novaes Hillegonda Maria Dutilh, Franco de Siqueira Arnaldo Augusto, Campbell Oona, Rodrigues Laura Cunha
Programa de Pós-Graduação, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Saude Publica. 2007 Dec;41(6):1013-22. doi: 10.1590/s0034-89102007000600017.
To assess risk factors for early neonatal mortality.
A population-based case-control study was carried out with 146 early neonatal deaths and a sample of 313 controls obtained among survivals of the neonate period in the south region of the city of São Paulo, in the period of 8/1/2000 to 1/31/2001. Information was obtained through home interviews and hospital charts. Hierarchical assessment was performed in five groups with the following characteristics 1) socioeconomic conditions of mothers and families, 2) maternal psychosocial conditions, 3) obstetrical history and biological characteristics of mothers, 4) delivery conditions, 5) conditions of newborns
Risk factors for early neonate mortality were: Group 1: poor education of household head (OR=1.6; 95% CI: 1.1;2.6), household located in a slum area (OR=2.0; 95% CI: 1.2;3.5) with up to one room (OR=2.2; 95% CI: 1.1;4.2); Group 2: mothers in recent union (OR=2.0; 95% CI: 1.0;4.2), unmarried mothers (OR=1.8; 95% CI: 1.1;3.0), and presence of domestic violence (OR=2.7; 95% CI: 1;6.5); Group 3: presence of complications in pregnancy (OR=8.2; 95% CI: 5.0;13.5), previous low birth weight (OR=2.4; 95% CI: 1.2;4.5), absence of pre-natal care (OR=16.1; 95% CI: 4.7;55.4), and inadequate pre-natal care (block 3) (OR=2.1; 95% CI: 2.0;3.5); Group 4: presence of clinical problems during delivery (OR=2.9; 95% CI: 1.4;5.1), mothers who went to hospital in ambulances (OR=3.8; 95% CI: 1.4;10.7); Group 5: low birth weight (OR=17.3; 95% CI: 8.4;35.6) and preterm live births (OR=8.8; 95% CI: 4.3;17.8).
Additionally to proximal factors (low birth weight, preterm gestations, labor complications and unfavorable clinical conditions in gestation), the variables expressing social exclusion and presence of psychosocial factors were also identified. This context may affect the development of gestation and hinder the access of women to health services. Adequate prenatal care could minimize the effect of these variables.
评估早期新生儿死亡的风险因素。
在圣保罗市南部地区进行了一项基于人群的病例对照研究，选取了146例早期新生儿死亡病例，并从2000年8月1日至2001年1月31日期间新生儿期存活者中抽取了313例作为对照样本。通过家庭访谈和医院病历获取信息。对具有以下特征的五组因素进行分层评估：1）母亲和家庭的社会经济状况；2）母亲的心理社会状况；3）母亲的产科病史和生物学特征；4）分娩条件；5）新生儿状况。
早期新生儿死亡的风险因素如下：第1组：户主教育程度低（比值比[OR]=1.6；95%置信区间[CI]：1.1；2.6），家庭位于贫民窟地区（OR=2.0；95%CI：1.2；3.5）且房间数不超过一间（OR=2.2；95%CI：1.1；4.2）；第2组：近期结婚的母亲（OR=2.0；95%CI：1.0；4.2）、未婚母亲（OR=1.8；95%CI：1.1；3.0）以及存在家庭暴力（OR=2.7；95%CI：1；6.5）；第3组：孕期有并发症（OR=8.2；95%CI：5.0；13.5）、既往低出生体重（OR=2.4；95%CI：1.2；4.5）、未接受产前护理（OR=16.1；95%CI：4.7；55.4）以及产前护理不足（第3组）（OR=2.1；95%CI：2.0；3.5）；第4组：分娩期间存在临床问题（OR=2.9；95%CI：1.4；5.1）、乘坐救护车前往医院的母亲（OR=3.8；95%CI：1.4；10.7）；第5组：低出生体重（OR=17.3；95%CI：8.4；35.6）和早产活产（OR=8.8；95%CI：4.3；17.8）。
除了近端因素（低出生体重、早产、分娩并发症和孕期不良临床状况）外，还确定了表示社会排斥和心理社会因素存在的变量。这种情况可能会影响孕期发育并阻碍妇女获得医疗服务。充分的产前护理可以将这些变量的影响降至最低。
