Graduate Program in Child and Adolescent Health, Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil.
Faculdade de Medicina - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil.
Sci Rep. 2020 Apr 29;10(1):7252. doi: 10.1038/s41598-020-64357-x.
Neonatal mortality still remains a complex challenge to be addressed. In Brazil, 60% of neonatal deaths occur among preterm infants with a gestational age of 32 weeks or less (≤32w). The aim of this study was to evaluate the factors involved in the high mortality rates among newborns with a gestational age ≤32w in a socioeconomically developed southern city in Brazil. Data on retrospective births and deaths (2000-2014) were analyzed from two official Brazilian national databases. The risk of neonatal death for all independent variables (mother's age and schooling, prenatal visits, birth hospital, delivery method, gestational age, and the newborn's sex, age, and birth year, gemelarity, congenital anomalies and birthplace) was assessed with a univariable and a multivariable model of Cox's semiparametric proportional hazards regression (p < 0.05). Data of 288,904 newborns were included, being 4,514 with a gestational age ≤32w. The proportion of these early newborns remained stable among all births, while the neonatal mortality rate for this group tended to decrease (p < 0.001). The adjusted risk was significantly for lower birthweight infants (mean 659.13 g) born from Caesarean (HR 0.58 [95% CI 0.47-0.71]), but it was significantly higher for heavier birth weight infants (mean 2,087.79) also born via Caesarean section (HR 3.71 [95% CI 1.5-9.15]). Newborns with lower weight seemed to benefit most from Cesarean deliveries. Effort towards reducing unacceptably high surgical deliveries must take into account cases that the operations may be lifesaving for mother and/or the baby.
新生儿死亡率仍然是一个需要解决的复杂挑战。在巴西，60%的新生儿死亡发生在胎龄为 32 周或以下（≤32w）的早产儿中。本研究旨在评估巴西南部一个社会经济发达城市胎龄≤32w 的新生儿高死亡率的相关因素。从两个官方的巴西国家数据库中分析了回顾性出生和死亡数据（2000-2014 年）。使用 Cox 半参数比例风险回归的单变量和多变量模型评估了所有独立变量（母亲年龄和教育程度、产前检查、分娩医院、分娩方式、胎龄以及新生儿的性别、年龄和出生年份、双胞胎、先天畸形和出生地）对新生儿死亡的风险（p<0.05）。共纳入 288904 名新生儿，其中 4514 名胎龄≤32w。这些早期新生儿在所有分娩中的比例保持稳定，而该组的新生儿死亡率呈下降趋势（p<0.001）。调整后的风险对于出生体重较低的婴儿（平均 659.13g）通过剖宫产分娩显著降低（HR 0.58 [95%CI 0.47-0.71]），但对于出生体重较高的婴儿（平均 2087.79g）通过剖宫产分娩显著增加（HR 3.71 [95%CI 1.5-9.15]）。体重较低的新生儿似乎从剖宫产中获益最大。为了降低不可接受的高剖宫产率，必须考虑到手术对母亲和/或婴儿可能是救生的情况。
