title: Neonatal mortality: description and effect of hospital of birth after risk adjustment.
abstract: OBJECTIVE
  To assess the effect of hospital of birth on neonatal mortality.
  
  
  METHODS
  A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offices. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model.
  
  
  RESULTS
  Neonatal mortality rate was 12.7 and it was highly influenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics.
  
  
  CONCLUSIONS
  Neonatal mortality was high, mainly related to immaturity, and varied significantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.
authors.affiliation: Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brasil. abarros.epi@gmail.com
authors.forename: Aluísio J D
authors.initials: AJ
authors.lastname: Barros
authors.forename: Alicia
authors.initials: A
authors.lastname: Matijasevich
authors.forename: Iná S
authors.initials: IS
authors.lastname: Santos
authors.forename: Elaine P
authors.initials: EP
authors.lastname: Albernaz
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005865:Gestational Age; D006771:Hospitals, Maternity / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011787:Quality of Health Care; D020379:Risk Adjustment; D012959:Socioeconomic Factors