Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2019 Aug 12;35(7):e00186418. doi: 10.1590/0102-311X00186418.
Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.
尽管五岁以下儿童死亡率有所下降，但这些死亡原因在很大程度上仍然是可以避免的，而且出生时的危及生命的情况可能会危及生存。本研究估计了出生时危及生命的情况、新生儿接近死亡和死亡的负担，重点关注可避免的原因，以及活产队列中五岁以下儿童的生存情况。这是对巴西里约热内卢市活产（2012-2016 年）的回顾性队列研究。巴西活产信息系统和巴西死亡率信息系统的数据库进行了链接。使用实用标准来定义危及生命的情况和接近死亡的情况。根据巴西可避免死亡原因清单对死亡进行分类。估计了发病率、死亡率和生存指标（Kaplan-Meier）。在 425505 例活产中，2.2%的新生儿在出生时存在危及生命的情况。五岁以下儿童、婴儿和新生儿死亡率分别为每 1000 人日 0.01、0.06 和 14.97。可避免、不清楚可避免和未明原因的死亡分别占死亡人数的 61%、35%和 4%。可避免死亡归因于出生时危及生命的情况的风险为 97.6%。与无危及生命的情况的新生儿相比，有危及生命的情况的新生儿的生存率较低。根据巴西可避免死亡原因清单中可避免死亡的三组原因，出生时危及生命的情况实用标准决定了按死亡原因划分的比例死亡率特征。出生时的危及生命的情况增加了五岁以下儿童发病和死亡的风险，并引发了对脆弱性以及对这些儿童的护理和家庭社会支持的需求的讨论。
