The Determinants of Infant Mortality in Brazil, 2010–2020: A Scoping Review

Bugelli, Alexandre; Silva, Roxane Borgès Da; Dowbor, Ladislau; Sicotte, Claude

doi:10.3390/ijerph18126464

Cited by 22 publications

(30 citation statements)

References 37 publications

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“…Several other background factors were not analyzed in the current study. It was previously observed that neonatal mortality rate did not differ significantly by mother's age, income, or employment status; on the other hand, mothers with a high school education or less were associated with a higher rate of neonatal deaths, likely due to a lack of awareness about how and when to seek medical care, particularly in emergency situations [1,40]. Some evidence indicates that advanced maternal age is connected with placental malfunction, which may raise the risk of newborn deaths and stillbirths or exacerbate pre-existing maternal medical conditions.…”

Section: Discussionmentioning

confidence: 88%

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The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

et al. 2022

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Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.

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Section: Discussionmentioning

confidence: 88%

“…Neonatal mortality is a public health issue that affects the world's poorest and middleincome countries the most [1]. Even though significant progress has been made in reducing infant mortality over the last three decades, further efforts are needed to improve survival rates and severe complications [2].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

et al. 2022

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“…For this reason, the supply of vaccines in the maternity ward and the referral for the continuity of the vaccination schedule in the UBS may also have provided the study with such association. Some studies found an association between the supply of vaccination and declining neonatal and infant mortality (Saso & Kampmann, 2017;Jensen et al, 2019;Bugelli et al, 2021b;Müller-Nordhorn, 2021).…”

Section: Discussionmentioning

confidence: 99%

Are Primary Health Care Features Associated with Reduced Late Neonatal Mortality in Brazil? An Ecological Study

Pasklan

Rocha

Queiroz

et al. 2021

Matern Child Health J

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Objective To analyze the effect and efficiency of the characteristics of PHC facilities' structures and the work process of PHC teams on late neonatal mortality (LNM). Methods This ecological time-series study adopted 3.764 Brazilian municipalities as analysis units. The independent variables were sorted into three hierarchical levels and four blocks. The distal level consisted of economic and demographic variables; the intermediate level comprised health coverage and demand for services; and the proximal level included structure and work process. The dependent variable was LNM. A linear mixed-effects regression analysis with a hierarchical approach was performed, estimating the crude (β) and adjusted (alpha = 5%) regression coefficients. Data involution analysis and municipalities were the decision-making unit according to their strata. Results LNM was directly associated with the number of live births and unemployment rate. LNM was inversely associated with the year, per capita income, the community health worker's strategy coverage, vaginal delivery, household visits, and available vaccines. In the 2002-2014 period, the number of municipalities efficient in reducing LNM dropped from 38 to 27. In 2014, a more significant investment occurred in the number of vaginal deliveries in almost all strata to make inefficient municipalities efficient. Conclusion for PracticeThe deaths of children aged 7-28 days are affected by the characteristics of the PHC structure and work process. Keyword Infant mortality • Neonatal mortality • Primary health care • Epidemiology of health services SignificanceWhat is Already Known? Studies show the effect of primary health care actions on the late neonatal mortality in developing countries. But they do not yet jointly consider the role of different elements of the structure and work process. What this Study Adds?The role of different elements of the structure and work process of primary health care teams affect late neonatal mortality: household visits, community health workers strategy coverage and increase the availability of vaccines.

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“…The country achieved a considerable reduction in the NMR, from 25.33/1000 in 1990 to 8.5/1000 live births in 2019, although it has recently shown a significant deceleration [1,2]. The improvement of socioeconomic and health policies, such as the implementation of the Unified Health System (SUS) [3]; the "Family Health Strategy" [4], the "Rede Cegonha" strategy, and the "Bolsa Família Program" [5,6], positively impacted the reduction of mortality rates. Still, the infant and child mortality indicators remain high by international standards, with a concentration of deaths in less developed regions, especially the Northern region of Brazil, which has the highest neonatal mortality rate with 11.02 per 1000 live births [1,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study

et al. 2022

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Background The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil. Methods This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed. Results After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60–6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19–0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU. Conclusion In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.

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The Determinants of Infant Mortality in Brazil, 2010–2020: A Scoping Review

Cited by 22 publications

References 37 publications

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

Are Primary Health Care Features Associated with Reduced Late Neonatal Mortality in Brazil? An Ecological Study

Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study

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