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Temporal Trend, Causes, and Timing of Neonatal Mortality of Moderate and Late Preterm Infants in São Paulo State,
Maria Fernanda B de Almeida1, Adriana Sanudo1, Kelsy N Areco1
1Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil.
Insights
Neonatal mortality for moderate and late preterm infants significantly decreased in Brazil. However, respiratory disorders, infections, and perinatal asphyxia remain leading causes of death, highlighting care gaps.
Area of Science:
- Neonatalogy
- Public Health
- Epidemiology
Background:
- Moderate and late preterm infants (32-36 weeks gestation) constitute a significant portion of births.
- Data on neonatal mortality for this group in middle-income countries is scarce.
- Congenital anomalies were excluded to focus on preventable causes.
Purpose of the Study:
- To analyze trends, causes, and timing of neonatal mortality.
- Focus on infants born between 32 and 36 weeks gestation without congenital anomalies.
- Study conducted in São Paulo State, Brazil, from 2004-2015.
Main Methods:
- Deterministic linkage of birth and death certificates.
- Classification of causes of death using ICD-10 codes.
- Statistical analysis including Prais-Winsten model for trend analysis.
Main Results:
- Neonatal mortality rate decreased from 16.4 to 7.6 per 1,000 live births (2004-2015).
- Infections (44%), respiratory disorders (27%), and perinatal asphyxia (14%) were primary causes of death.
- Median time to death varied by cause: 24h (asphyxia), 53h (respiratory), 168h (infections).
Conclusions:
- Significant reduction in neonatal mortality observed.
- Persistent challenges in addressing infections, respiratory issues, and asphyxia.
- Need for improved perinatal care policies to further reduce preventable deaths in preterm infants.
Abstract:
Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7-366/7 weeks gestation without congenital anomalies from 2004-2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7-366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais-Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.
