Costa-Nobre Daniela Testoni, Marinonio Ana Sílvia Scavacini, Miyoshi Milton Harumi, Sanudo Adriana, Areco Kelsy Catherina Nemo, Kawakami Mandira Daripa, Balda Rita de Cássia Xavier, Konstantyner Tulio, Vieira E Oliveira Carina Nunes, Bandiera-Paiva Paulo, de Freitas Rosa Maria Vieira, Teixeira Monica La Porte, Waldvogel Bernadette, de Almeida Maria Fernanda, Guinsburg Ruth, Kiffer Carlos Roberto Veiga
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Gerência Demográfica da Fundação Sistema Estadual de Análise de Dados (Fundação SEADE), São Paulo, Brazil.
Epidemiol Infect. 2024 Dec 13;152:e169. doi: 10.1017/S0950268824001663.
Our study aim was to identify high-risk areas of neonatal mortality associated with bacterial sepsis in the state of São Paulo, Southeast Brazil. We used a population-based study applying retrospective spatial scan statistics with data extracted from birth certificates linked to death certificates. All live births from mothers residing in São Paulo State from 2004 to 2020 were included. Spatial analysis using the Poisson model was adopted to scan high-rate clusters of neonatal mortality associated with bacterial sepsis (WHO-ICD10 A32.7, A40, A41, P36, P37.2 in any line of the death certificate). We found a prevalence of neonatal death associated with bacterial sepsis of 2.3/1000 live births. Clusters of high neonatal mortality associated with bacterial sepsis were identified mainly in the southeast region of the state, with four of them appearing as cluster areas for all birth weight categories (<1500 g, 1500 to <2500 g and ≥ 2500 g). The spatial analysis according to the birth weight showed some overlapping in the detected clusters, suggesting shared risk factors that need to be explored. Our study highlights the ongoing challenge of neonatal sepsis in the most developed state of a middle-income country and the importance of employing statistical techniques, including spatial methods, for enhancing surveillance and intervention strategies.
我们的研究目的是确定巴西东南部圣保罗州与细菌性败血症相关的新生儿死亡高风险地区。我们采用了一项基于人群的研究，应用回顾性空间扫描统计方法，数据提取自与死亡证明相关联的出生证明。纳入了2004年至2020年居住在圣保罗州的母亲所生的所有活产儿。采用泊松模型进行空间分析，以扫描与细菌性败血症相关的新生儿死亡率高的聚集区（死亡证明任何一行中的世界卫生组织国际疾病分类第十版编码A32.7、A40、A41、P36、P37.2）。我们发现，与细菌性败血症相关的新生儿死亡患病率为2.3/1000活产儿。与细菌性败血症相关的新生儿死亡率高的聚集区主要在该州东南部地区被发现，其中有四个聚集区在所有出生体重类别（<1500克、1500至<2500克和≥2500克）中均表现为聚集区域。根据出生体重进行的空间分析显示，检测到的聚集区存在一些重叠，这表明需要探索共同的风险因素。我们的研究凸显了在一个中等收入国家最发达的州，新生儿败血症这一持续存在的挑战，以及采用包括空间方法在内的统计技术来加强监测和干预策略的重要性。
