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Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country

BACKGROUND: It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during...

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Autores principales: Kawakami, Mandira D., Sanudo, Adriana, Teixeira, Mônica L. P., Andreoni, Solange, de Castro, Josiane Q. X., Waldvogel, Bernadette, Guinsburg, Ruth, de Almeida, Maria Fernanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913394/
https://www.ncbi.nlm.nih.gov/pubmed/33639885
http://dx.doi.org/10.1186/s12884-021-03652-5
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author Kawakami, Mandira D.
Sanudo, Adriana
Teixeira, Mônica L. P.
Andreoni, Solange
de Castro, Josiane Q. X.
Waldvogel, Bernadette
Guinsburg, Ruth
de Almeida, Maria Fernanda
author_facet Kawakami, Mandira D.
Sanudo, Adriana
Teixeira, Mônica L. P.
Andreoni, Solange
de Castro, Josiane Q. X.
Waldvogel, Bernadette
Guinsburg, Ruth
de Almeida, Maria Fernanda
author_sort Kawakami, Mandira D.
collection PubMed
description BACKGROUND: It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. METHODS: Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. RESULTS: Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. CONCLUSIONS: There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.
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spelling pubmed-79133942021-03-02 Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country Kawakami, Mandira D. Sanudo, Adriana Teixeira, Mônica L. P. Andreoni, Solange de Castro, Josiane Q. X. Waldvogel, Bernadette Guinsburg, Ruth de Almeida, Maria Fernanda BMC Pregnancy Childbirth Research Article BACKGROUND: It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. METHODS: Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. RESULTS: Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. CONCLUSIONS: There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care. BioMed Central 2021-02-27 /pmc/articles/PMC7913394/ /pubmed/33639885 http://dx.doi.org/10.1186/s12884-021-03652-5 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Kawakami, Mandira D.
Sanudo, Adriana
Teixeira, Mônica L. P.
Andreoni, Solange
de Castro, Josiane Q. X.
Waldvogel, Bernadette
Guinsburg, Ruth
de Almeida, Maria Fernanda
Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
title Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
title_full Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
title_fullStr Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
title_full_unstemmed Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
title_short Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
title_sort neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913394/
https://www.ncbi.nlm.nih.gov/pubmed/33639885
http://dx.doi.org/10.1186/s12884-021-03652-5
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