Fetal, neonatal, and post-neonatal mortality in the 2015 Pelotas (Brazil) birth cohort and associated factors

Abstract

This study aimed to describe fetal, neonatal, and post-neonatal mortality and associated factors in participants of the 2015 Pelotas (Brazil) birth cohort. The child mortality sub-study followed up all deaths in the first year of life. Data were collected on intrauterine fetal deaths (weight ≥ 500g and/or gestational age ≥ 20 weeks), neonatal deaths (< 28 days of life), and post-neonatal deaths (from 28 days to the end of the first year of life). Descriptive analyses using the Pearson chi-square test and a multinomial logistic regression to estimate the risk of fetal, neonatal, and post-neonatal deaths compared to live infants in the cohort (reference group) were performed. Data from 4,329 eligible births were collected, of which 54 died during the fetal period. Of the 4,275 eligible live births, 59 died in the first year of life. An association between fetal, neonatal, and post-neonatal deaths (OR = 15.60, 7.63, and 5.51 respectively) was found, as well as less than six prenatal consultations. Compared to live infants, fetal deaths were more likely to occur in non-white mothers, and neonatal deaths were 14.09 times more likely to occur in a preterm gestational age (< 37 weeks). Compared to live infants, infants that were born in a C-section delivery had 3.71 increased odds of post-neonatal death. Additionally, neonatal deaths were 102.37 times more likely to have a low Apgar score on the fifth minute after birth. These findings show the need for early interventions during pregnancy, ensuring access to adequate prenatal care.

Risk Factors for Early Neonatal Death despite Cesarean Section

“…Newborns with 5 th min Apgar score ˂7 had an OR of 58.63 of dying within the seven days following CS. Some authors found an OR of more than 102 of dying when the 5 th min Apgar score was ˂7 [15].…”

Magnitude e determinantes da mortalidade neonatal e pós-neonatal em Goiânia, Goiás: um estudo de coorte retrospectivo, 2012

“…[16][17][18] Analysis of the factors associated with neonatal and postneonatal mortality showed that the inadequate number of prenatal care visits was statistically significant for both these components of infant mortality. 1,20 Quality prenatal care, with an adequate number of consultations, laboratory tests and paying due attention to intercurrences, reduces risk of complications during pregnancy and childbirth. 20 A study which assessed a population with characteristics similar to those of Goiânia found that neonatal mortality can be reduced by up to 34% by implementing quality prenatal monitoring.…”

“…1,20 Quality prenatal care, with an adequate number of consultations, laboratory tests and paying due attention to intercurrences, reduces risk of complications during pregnancy and childbirth. 20 A study which assessed a population with characteristics similar to those of Goiânia found that neonatal mortality can be reduced by up to 34% by implementing quality prenatal monitoring. 21 Low birth weight and premature birth were the determinants with the highest odds ratios in the neonatal period.…”

Fatores associados à internação e à mortalidade neonatal em uma coorte de recém-nascidos do Sistema Único de Saúde, no município de São Paulo

“…Factors that cause hospitalization of pregnant women, such as obstetric complications 3 , inadequate prenatal care 3 , cesarean delivery, vaginal bleeding 4,5 , low education 6 and premature births, with low weight and congenital malformation 3,5 , are associated with neonatal mortality.…”

“…Most studies on this topic in the country are carried out based on secondary data 3,4 originating from the Mortality Information System (Sistema de Informação sobre Mortalidade -SIM) and the Live Birth Information System (Sistema de Informações sobre Nascidos Vivos -SINASC), which do not have data on the care received by newborns (NB) or their mothers during pregnancy. Other studies used primary data 6,7 and reported the admission of pregnant women or maternal morbidity to the neonatal mortality causality network.…”