Neonatal deaths of low birth weight newborns

To analyze the main characteristics of low birth weight infants that deceased in Cuiabá, Mato Grosso. A study conducted from a cohort composed of live infants with birth weight of 500 -2499 grams who progressed to death before completing 28 days of life. The data were obtained from the Live Births Information System and Mortality Information System. Of the 3,404 studied newborns, 238 progressed to death (7.0%). Prevalent deaths were among males, weighing between 500 and 999 grams, Apgar < 7 in the first and fifth minute with a congenital anomaly (p<0.001); with mothers younger than 20 years (p=0.033); who attended one to six prenatal appointments (p=<0.001). The results showed that neonatal deaths were related to the quality of obstetric and neonatal attention, as they were mostly avoidable deaths. Descriptors: Low Birth Weight; Epidemiology Descriptive; Infant Mortality; Pediatric Nursing. Received: 05/31/2017. Accepted: 03/01/2018. Published: 09/19/2018. 1 Nurse, Ph.D. in Public Health Nursing. Associate Professor at Mato Grosso Federal University. Cuiabá, MT, Brazil. E-mail: mamgaiva@yahoo.com. br. 2 Nurse. Temporary Professor at Mato Grosso Federal University. Barra do Garças, MT, Brazil. E-mail: fernanda.sanchesperes@gmail.com. 3 Nurse. Ph.D. in Sciences. Full Professor at Cuiabá University. Cuiabá, MT, Brazil. E-mail: silvana_benevides@hotmail.com. 4 Nurse, Master of Nursing. Student of the Nursing Graduate Program, Doctoral level, at Mato Grosso Federal University. Professor at Mato Grosso State University. Cuiabá, MT, Brazil. E-mail: leandro.mufato@gmail.com. Suggest citation: Gaíva MAM, Lopes FSP, Ferreira SMB, Mufato LF. Neonatal deaths of low birth weight newborns. Rev. Eletr. Enf. [Internet]. 2018 [cited ____________];20:v20a18. Available from: https://doi.org/10.5216/ree.v20. 47222. Gaíva MAM, Lopes FSP, Ferreira SMB, Mufato LF. Rev. Eletr. Enf. 2018;20:v20a18. doi: 10.5216/ree.v20. 47222. 2 INTRODUCTION Babies with low birth weight are vulnerable to the risk of death, especially early death, besides health problems, in comparison to newborns with adequate weight. Currently, in Brazil, the low birth weight (LBW) represents alone the primary risk factor associated to death during the neonatal period, being present in 65% of deaths in the first 28 days of life(1). Thus, improvements in the quality of pre-natal attention reflect the decrease of the neonatal mortality index, as well as, investments of the health services in the quality of delivery assistance(2). The World Health Organization (WHO) defines that every baby born weighing less than 2,500 grams is considered low birth weight infant, and still, can be classified as extreme low birth weight (≤ 999 grams) or very low birth weight (≤ 1.499 grams) (3). The LBW can be related to premature delivery, birth before 37 gestational weeks, as well as, associated with the restriction of intrauterine growth or the relationship between both situations. It is estimated that per year, 15 to 20% of all births in the world are LBW(3). LBW newborns have been the object of many studies in countries like Colombia, India, Indonesia, Taiwan and Africa, investigating not only the predictors of neonatal mortality but also risk factors for birth with low weight(4-6). In the national context, despite the high levels of neonatal mortality among LBW newborns, few are the studies analyzing mortality in this group of children(7-9), as well as in Cuiabá, capital of a State in the CentralWest Brazilian region(10). Considering the presence of differences in neonatal mortality in different regions of the country, that maternal and newborn characteristics have an important role in birth conditions and infant survival and, that neonatal mortality represents 67.1% of the total deaths in Cuiabá(11), the conduction of this study is justified. It aims to analyze the main characteristics of low birth weight infants who deceased in Cuiabá, Mato Grosso. METHODS A descriptive study of a cohort of all low birth weight newborns, residents of Cuiabá/MT, Brazil, who progressed to death during the neonatal period, between 01 January 2011 and 31 December 2014. The data was collected of the Live Births Declaration (LBD) and Death Declaration (DD), available by the Epidemiological Vigilance of the Health State Secretary of Mato Grosso. The data was organized in two sets with the information extracted from each declaration (LBD and DD), respectively. After, the linkage technique was applied between the two datasets. This technique consists in the integration of information of two or more independent sets, through common variables. It has been broadly used as it favors the recovery of incomplete and inconsistent registries contributing to the improvement of information quality. The deterministic linkage was done through the Excel® software, from the connection of key-fields: LBD number; date of birth; sex and maternal age. The integration of sets resulted in 96.5% of connection. A new dataset was built, and the variables were selected and categorized according to LBD and DD. During the studied period, we had 3,477 low birth weight newborns, and in the sample selection process the NB with birth weight lower than 500 grams (69) and anencephalic (04) were excluded, resulting in the total sample of 3,404 live low birth weight newborns. From those, 238 progressed to death. Thus, we included 3,166 LWB newborns survivors and 238 LWB newborns who died during the neonatal period. Gaíva MAM, Lopes FSP, Ferreira SMB, Mufato LF. Rev. Eletr. Enf. 2018;20:v20a18. doi: 10.5216/ree.v20. 47222. 3 The following variables were selected for analysis: from the newborn (birth weight; sex; Apgar in the 1st and 5th minute and presence of anomaly), from the mothers (age, color/race, marital status and occupation); from the assistance (type of delivery; type of pregnancy; pre-natal consultation; pregnancy duration and place of birth. The primary cause of neonatal deaths was also analyzed and obtained in the Mortality Information System (SIM), which has a reference the International Classification of Diseases – 10th revision (ICD 10). For data management and analysis, the Microsoft Excel® 2016 Program and the Statistical Package for the Social Sciences (SPSS) version 17.0 were used. The Chi-Square (c2) test was used to compare proportions according to the relative frequency of variables related to deaths, with a significance level of 5% (p <0.05) and for the analysis of primary causes of fatalities, absolute and relative frequencies were used. The research project was approved by the Ethics in Research Committee, under the protocol no 1283.468/2015 in consonance with the CNS Resolution no 466/2012 of the National Health Council. RESULTS From the 3,404 newborns included in the study, 238 progressed to death (7.0%). The neonatal mortality rate was 70 deaths/1000 LB. The highest number of deaths, 177 (74.4%) occurred during the early neonatal period (rate of 52 deaths/1000 LB). From those, 73 (41.2%) were in the first 24 hours after delivery and 61 (25.6%) in the late neonatal period (18 deaths/1000 LB). There was a higher prevalence of deaths (55.3%) among male LWB newborns, weighing between 500-999 grams (49.2%), Apgar < 7 in the first minute (84.9%) and in the fifth minute of life (56.7%) and with congenital anomaly (12.2%) (p < 0.05) when compared to those who survived, and this difference was statistically significant (<0.05) (Table 1). Table 1: Characteristics related to low birth weight newborns who died and survived according to variables related to the newborn. Cuiabá, MT, Brazil, 2011-2014. Neonatal Characteristics Low birth weigth newborns c2 (p-value) Deaths Survivors* Total sample n (238) % n (3166) % n (3404) % Sex* Male 131 55.3 1427 45.1 1558 45.8 9.24 (0.002) Female 106 44.7 1739 54.9 1845 54.2 1 Birth weight (g) 500 to 999 117 49.2 100 3.1 217 6.4 942.41 (<0.001) 1,000 to 1,499 52 21.8 274 8.7 326 9.6 146.87 (<0.001) 1,500 to 2,499 69 29.