Neonatal mortality in intensive care units of central Brazil

Resumo

Objective: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. Methods: A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatalbased mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox’s proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. Results: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. Conclusions This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.

Descrição

Palavras-chave

Infant mortality, Intensive care units neonatal, Infant, Low birth weight, Information systems, Mortality rate, Mortalidade infantil, Unidades de terapia intensiva neonatal, Recém nascido de baixo peso, Sistemas de informação, Coeficiente de mortalidade

Citação

WEIRICH, Claci Fátima et al. Neonatal mortality in intensive care units of central Brazil. Revista de Saúde Pública, São Paulo, v. 39, n. 5, p. 775-781, 2005.