title: Perinatal asphyxia associated with early neonatal mortality: populational study of avoidable deaths.
abstract: OBJECTIVE
  To compare the epidemiological profile of avoidable early neonatal deaths associated with perinatal asphyxia according to region of death in the State of São Paulo, Brazil.
  
  
  METHODS
  Population-based cohort study including 2,873 avoidable deaths up to six days of life associated with perinatal asphyxia from January 2001 to December 2003. Perinatal asphyxia was considered if intrauterine hypoxia, birth asphyxia, or meconium aspiration syndrome were written in any line of the original Death Certificate. Epidemiological data were also extracted from the Birth Certificate.
  
  
  RESULTS
  During the three years, 1.71 deaths per 1,000 live births were associated with perinatal asphyxia, which corresponded to 22% of the early neonatal deaths. From the 2,873 avoidable deaths, 761 (27%) occurred in São Paulo city; 640 (22%), in the metropolitan region of São Paulo city; and 1,472 (51%), in the countryside of the state. In the first two regions, deaths were more frequent in public hospitals, among newborns with gestational age of 36 weeks or less, and among babies weighing less than 2500g. In the countryside, mortality was more frequent in philanthropic hospitals, in term newborns and in neonates weighing over 2500g. Most of these neonates were born during daytime in their hometown and died at the same institution in which they were born within the first 24 hours after delivery. Meconium aspiration syndrome was related to 18% of the deaths.
  
  
  CONCLUSIONS
  Perinatal asphyxia is a frequent contributor to the avoidable early neonatal death in the state with the highest gross domestic product per capita in Brazil, and it shows the need for specific interventions with regionalized focus during labor and birth care.
authors.affiliation: EPM, Unifesp, São Paulo, SP, Brasil. daripa@hotmail.com
authors.forename: Mandira
authors.initials: M
authors.lastname: Daripa
authors.forename: Helena Maria G
authors.initials: HM
authors.lastname: Caldas
authors.forename: Luis Patricio O
authors.initials: LP
authors.lastname: Flores
authors.forename: Bernadette Cunha
authors.initials: BC
authors.lastname: Waldvogel
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
authors.forename: Maria Fernanda B
authors.initials: MF
authors.lastname: de Almeida
mesh_terms: D001238:Asphyxia Neonatorum / Q000401:mortality* / Q000517:prevention & control; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male