Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Universidade Federal Fluminense, Niterói, RJ, Brazil.
Rev Paul Pediatr. 2022 Nov 14;41:e2021302. doi: 10.1590/1984-0462/2023/41/2021302. eCollection 2022.
The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015.
Population-based retrospective cohort of live births (LB) of single pregnancy with 0-27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately.
The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added.
Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers - low education level and brown or black skin colors - were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.
本研究旨在调查 2015 年巴西里约热内卢市活产队列中与新生儿近危和死亡相关的因素。
本研究为基于人群的单胎妊娠活产回顾性队列研究，随访时间为 0-27 天。数据来自巴西活产和死亡率信息系统。使用分层确定分析策略的逻辑回归分别对近危病例和死亡病例进行分析。
该队列由 85850 例活产组成。每一千例活产中，约有 16 例为近危病例，6 例死亡。母亲的教育程度、肤色和年龄以及产前保健的充分性与新生儿近危有关；对于死亡病例，还增加了分娩时的 LB 表现、出生体重、胎龄和 5 分钟 Apgar 评分。
除了确认低出生体重、早产和窒息对新生儿死亡的影响外，社会经济脆弱性指标——低教育水平和棕色或黑色皮肤颜色——也与新生儿死亡和近危有关。产前保健缺失或不足与这两种结局均有很强的关联，对新生儿死亡的关联更强。里约热内卢需要投资提高产前保健质量，减少医疗保健方面的差距。
