title: Perinatal factors associated with early neonatal deaths in very low birth weight preterm infants in Northeast Brazil.
abstract: BACKGROUND
  In Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period. Therefore, this study aims at assessing perinatal factors associated with early neonatal deaths in very low birth weight preterm infants born in a region of Brazil with low Human Development Index.
  
  
  METHODS
  Prospective cohort study of inborns with gestational age 23(0/7)-31(6/7) weeks and birthweight 500-1499 g without malformations in 19 public reference hospitals of the state capitals of Brazil's Northeast Region. Perinatal variables associated with early neonatal death were determined by Cox regression analysis.
  
  
  RESULTS
  Among 627 neonates, 179 (29%) died with 0-6 days after birth. Early death was associated to: absence of antenatal steroids (HR 1.59; 95% CI 1.11-2.27), multiple gestation (1.95; 1.28-3.00), male sex (2.01; 1.40-2.86), 5th minute Apgar <7 (2.93; 2.03-4.21), birthweight <1000 g (2.58; 1.70-3.88), gestational age <28 weeks (2.07; 1.42-3.02), use of surfactant (1.65; 1.04-2.59), and non-use of a pain scale (1.89; 1.24-2.89).
  
  
  CONCLUSIONS
  Biological variables and factors related to the quality of perinatal care were associated with the high chance of early death of preterm infants born in reference hospitals of Northeast Brazil.
authors.affiliation: Neonatal Unit of Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, 3678 aptº 1600 - Meireles, CEP: 60165-121, Fortaleza, CE, Brazil. evelinecamposmc@gmail.com.
authors.forename: Eveline Campos Monteiro de
authors.initials: EC
authors.lastname: Castro
authors.affiliation: Department of Maternal and Child Health, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil. alvaromadeiro@yahoo.com.br.
authors.forename: Álvaro Jorge Madeiro
authors.initials: ÁJ
authors.lastname: Leite
authors.affiliation: Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil. fernandaalmeida@uol.com.br.
authors.forename: Maria Fernanda Branco de
authors.initials: MF
authors.lastname: Almeida
authors.affiliation: Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil. ruthgbr@netpoint.com.br.
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
mesh_terms: D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D011663:Pulmonary Surfactants