Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil.
Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), São Paulo, São Paulo, Brazil.
Am J Perinatol. 2024 May;41(S 01):e298-e304. doi: 10.1055/s-0042-1754410. Epub 2022 Aug 16.
This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths.
This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI.
A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23).
During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants.
· RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..
本文旨在报告巴西圣保罗州早产儿呼吸窘迫综合征（RDS）相关新生儿死亡率的时间序列，并确定与这些死亡相关的社会、产妇和新生儿特征。
这是一项基于人群的研究，纳入了 2004 年至 2015 年期间在圣保罗州居住的所有孕龄（GA）为 22 至 36 周、出生体重≥400g、无先天性畸形的活产儿。RDS 相关新生儿死亡定义为出生后 27 天内死亡，ICD-10 编码为 P22.0 或 P28.0。采用普赖斯-温斯坦（Prais-Winsten）分析 RDS 相关新生儿死亡率（年度百分比变化[APC]及其 95%置信区间[95%CI]）。Kaplan-Meier 估计器确定 RDS 相关新生儿死亡发生的出生后时间。泊松回归模型比较了存活至新生儿期的早产儿和 RDS 相关新生儿死亡的产妇和新生儿的社会特征，结果以发病率比和 95%CI 表示。
共纳入 645276 例早产儿，其中 612110 例存活，11078 例发生 RDS 相关新生儿死亡。RDS 相关新生儿死亡率为每千例早产儿 17.17 例，呈逐年下降趋势（APC：-6.50%；95%CI：-9.11 至-3.82%）。这些死亡的中位时间为出生后 48 小时。确定 RDS 相关新生儿死亡的风险因素包括：母亲受教育程度≤7 年（1.18；1.09-1.29）、产前护理就诊次数为 0-3 次（1.25；1.18-1.32）、多胎妊娠（1.24；1.16-1.33）、阴道分娩（1.29；1.22-1.36）、GA 为 22-27 周（106.35；98.36-114.98）、GA 为 28-31 周（20.12；18.62-21.73）、男性（1.16；1.10-1.22）和 5 分钟 Apgar 评分为 0-3 分（6.74；6.08-7.47）和 4-6 分（3.97；3.72-4.23）。
在研究期间，RDS 相关新生儿死亡率呈显著下降趋势。RDS 相关新生儿死亡与社会、产妇和新生儿因素之间的关系表明，需要制定围产期策略来降低早产率，并改善早产儿的初始管理。
· RDS 与早产儿有关。· 中低收入国家 RDS 相关新生儿死亡率的影响鲜为人知。· 高质量的围产期护理可以降低 RDS 相关新生儿死亡率。
