Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil.
Cad Saude Publica. 2023 Jun 26;39(6):e00231022. doi: 10.1590/0102-311XPT231022. eCollection 2023.
Intrauterine growth restriction and prematurity determine low birth weight. The combination of the three conditions results in different neonatal phenotypes that interfere with child survival. Neonatal prevalence, survival and mortality were estimated according to neonatal phenotypes in the cohort of live births in 2021 in the state of Rio de Janeiro, Brazil. In this study, live births of multiple pregnancies, with congenital anomalies and inconsistencies in the information of weight and gestational age were excluded. The Intergrowth curve was used to classify weight adequacy. Mortality (< 24 hours, 1-6 and 7-27 days) and survival (Kaplan-Meier) were estimated. In total, 6.8%, 5.5%, and 9.5% of the 174,399 live births were low birth weight, small for gestational age (SGA), and premature, respectively. Considering low birth weight live births, 39.7% were SGA and 70% were premature. The neonatal phenotypes were heterogeneous according to maternal, delivery, pregnancy, and newborn characteristics. The mortality rate per 1,000 live births was high for low birth weight premature newborns, both SGA (78.1) and AGA (adequate for gestational age: 61.1), at all specific ages. Reductions in the survival rate were observed when comparing non-low birth weight and AGA term live births. The estimated prevalence values were lower than those of other studies, partly due to the exclusion criteria adopted. The neonatal phenotypes identified children who were more vulnerable and at higher risk of death. Prematurity contributed more to mortality than SGA, and its prevention is necessary to reduce neonatal mortality in the state of Rio de Janeiro.
宫内生长受限和早产决定了低出生体重。这三种情况的结合导致了不同的新生儿表型，这些表型干扰了儿童的生存。根据巴西里约热内卢州 2021 年活产儿队列中新生儿表型，估计了新生儿的患病率、存活率和死亡率。在这项研究中，排除了多胎妊娠、先天性异常以及体重和胎龄信息不一致的活产儿。使用 Intergrowth 曲线对体重充足性进行分类。估计了死亡率（<24 小时、1-6 天和 7-27 天）和存活率（Kaplan-Meier）。在 174399 例活产儿中，分别有 6.8%、5.5%和 9.5%为低出生体重、小于胎龄儿（SGA）和早产。考虑到低出生体重的活产儿，39.7%为 SGA，70%为早产。根据产妇、分娩、妊娠和新生儿特点，新生儿表型存在异质性。每 1000 例活产儿的死亡率对于低出生体重早产儿、SGA（AGA：78.1）和足月（61.1）早产儿均较高，在所有特定年龄段均较高。与非低出生体重和 AGA 足月活产儿相比，存活率下降。估计的患病率值低于其他研究，部分原因是采用了排除标准。所确定的新生儿表型确定了更脆弱和死亡风险更高的儿童。早产比 SGA 对死亡率的贡献更大，因此预防早产对于降低里约热内卢州的新生儿死亡率是必要的。
