Ribeiro Adolfo Monteiro, Guimarães Maria José, Lima Marilia de Carvalho, Sarinho Silvia Wanick, Coutinho Sonia Bechara
Hospital das Clínicas, Universidade de Pernambuco, Recife, PE, Brazil.
Rev Saude Publica. 2009 Apr;43(2):246-55. doi: 10.1590/s0034-89102009005000004. Epub 2009 Feb 13.
To analyze the risk factors associated with neonatal deaths among children with low birth weight.
A cohort study was carried out on live births weighing between 500 g and 2,499 g from single pregnancies without anencephaly in Recife (Northeastern Brazil) between 2001 and 2003. Data on 5,687 live births and 499 neonatal deaths obtained from the Live Birth Information System and the Mortality Information System were integrated through the linkage technique. Using a hierarchical model, variables from the distal level (socioeconomic factors), intermediate level (healthcare factors) and proximal level (biological factors) were subjected to univariate analysis and multivariate logistic regression.
After adjusting the variables through multivariate logistic regression, the factors from the distal level that remained significantly associated with neonatal death were: cohabitation by the parents, number of live births and type of maternity hospital. At the intermediate level, the factors were: number of prenatal consultations, complexity of the maternity hospital and type of delivery. At the proximal level, the factors were: sex, gestational age, birth weight, Apgar score and presence of congenital malformation.
The main factors associated with neonatal mortality among low weight live births are related to prenatal and postnatal care. Such factors are reducible through health sector actions.
分析低出生体重儿中与新生儿死亡相关的危险因素。
对2001年至2003年在巴西东北部累西腓单胎妊娠、体重在500克至2499克之间且无无脑畸形的活产儿进行队列研究。通过关联技术整合从活产信息系统和死亡信息系统获得的5687例活产儿和499例新生儿死亡的数据。使用分层模型,对来自远端水平(社会经济因素)、中间水平(医疗保健因素)和近端水平(生物学因素)的变量进行单因素分析和多因素逻辑回归。
通过多因素逻辑回归对变量进行调整后,与新生儿死亡仍显著相关的远端水平因素为:父母同居、活产数和产科医院类型。在中间水平,因素为:产前检查次数、产科医院的复杂性和分娩类型。在近端水平,因素为:性别、胎龄、出生体重、阿氏评分和先天性畸形的存在。
低体重活产儿中与新生儿死亡率相关的主要因素与产前和产后护理有关。通过卫生部门的行动,这些因素是可以降低的。