Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers.
OBJECTIVE
To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g.


METHODS
A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression.


RESULTS
A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth.


CONCLUSIONS
Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.
Disciplina de Pediatra Neonatal, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil.
Maria Fernanda Branco de
MF
Almeida
Ruth
R
Guinsburg
Francisco Eulógio
FE
Martinez
Renato S
RS
Procianoy
Cléa Rodrigues
CR
Leone
Sérgio Tadeu Martins
ST
Marba
Lígia Maria Sousa Suppo
LM
Rugolo
Jorge Hecker
JH
Luz
José Maria de Andrade
JM
Lopes
D001034:Apgar Score; D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005865:Gestational Age; D017052:Hospital Mortality; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards / Q000706:statistics & numerical data; D015931:Intensive Care, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000592:standards* / Q000706:statistics & numerical data; D011295:Prenatal Care; D019984:Quality Indicators, Health Care; D012041:Regional Medical Programs; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality