Independent risk factors associated with infant deaths

A cross-sectional study using secondary data recorded in public information systems for eleven years. The association of mortality rates was observed according to death periods using univariate and multivariate regression tests.

RESULTS:

The infant mortality rate decreased by 20.7 % in the study period. The list of independent factors associated with infant deaths shows the necessity for measures to increase public actions aimed at the early onset of prenatal care, continuing until the postpartum, puerperal period and in the growth and development of the newborn.

CONCLUSION:

The independent risk factors for infant death were low birth weight, gestation duration of less than 37 weeks, multiple pregnancy, maternal educational level lower than eight years, Apgar score and less than seven antenatal pregnancy.

Maternal-child nursing; Primary care nursing; Child mortality; Infant mortality; Medical order entry systems; Risk factors

Variables	1º. Triennium		2º. Triennium		3º. Triennium		4º. Triennium
Variables	53 deaths		36 deaths		48 deaths		42 deaths
Maternal variables
Age
< 20	13	24.5	8	22.2	14	29.2	10	23.8
20-34	35	66.0	20	55.5	27	56.3	24	57.1
≥ 35	5	9.4	8	22.2	07	14.6	8	19.0
Level of education (years)
Up to 7	35	66.0	11	30.6	13	27.1	13	30.9
8 or more	18	33.9	25	69.4	35	72.9	29	69.0
Marital status
Living without partner	18	33.9	20	55.6	28	58.3	29	69.0
Living with partner	35	66.0	16	44.4	20	41.7	13	30.9
Type of gestation
Single	38	71.7	30	83.3	48	100	39	92.8
Multiple	15	28.3	6	16.6	-	-	3	7.1
Newborn variables
Sex
Male	28	52.8	19	52.7	23	47.9	21	50.0
Female	25	47.1	17	47.2	25	52.1	21	50.0
Birth weight (g)
< 2500	33	62.2	25	69.4	29	60.4	31	73.8
≥ 2500	20	37.7	11	30.5	19	39.6	11	26.1
Duration of gestation (weeks)
< 37	30	56.6	22	61.1	18	37.5	30	71.4
≥ 37	23	43.4	14	38.9	28	58.3	12	28.5
Apgar (^1st min)
< 7	34	64.2	25	69.4	25	52.1	22	52.3
≥ 7	19	35.8	11	30.5	23	47.9	20	47.6
Apgar (5^th min)
< 7	26	49.0	14	38.9	16	33.3	17	40.4
≥ 7	27	50.9	22	61.1	32	66.7	25	59.5
Race/color
White	46	86.8	35	97.2	45	93.7	35	83.3
Others	07	13.2	01	2.8	03	6.2	07	16.6
Assistance variables
Type of delivery
Vaginal	36	67.9	21	58.3	25	52.1	18	42.8
Cesarean	17	32.0	15	41.7	23	47.9	24	57.1
Number of prenatal consultations
< 7	39	73.6	20	55.5	29	60.4	29	69.0
≥ 7	14	26.4	16	44.4	19	39.6	13	30.9

Variables	2000 - 2002				2009 - 2011
Variables	Death (n=53)	Live (n=3468)	Crude Oddis Ratio	p-value	Death (n=42)	Live (n=3423)	Crude Oddis Ratio	p-value
Maternal variables
Age
10-19 20-34 ≥35	13 35 05	633 2653 182	1.56 1.00 2.08	0.1735	10 24 08	533 2612 278	2.04 1.00 3.13	0.0359
Level of education (years)
Up to 7 8 or more	35 18	1476 1992	2.62 1.00	0,0006	13 29	504 2919	2.60 1.00	0.0033
Marital status
Living without partner Living with partner	16 37	1080 2388	0.96 1.00	0.8817	29 13	1318 2105	3.56 1.00	< 0.0001
Type of gestation
Single Multiple	38 15	3398 70	1.00 19.16	< 0.0001	39 03	3381 42	1.00 6.83	< 0.0001
Newborn variables
Sex
Male Female	29 24	1680 1788	1.29 1.00	0.3644	21 21	1665 1758	1.06 1.00	0.8610
Birth weight (g)
< 2500 ≥ 2500	34 19	366 3102	15.17 1.00	< 0.0001	31 11	331 3092	26.33 1.00	< 0.0001
Duration of gestation (weeks)
≤ 36 ≥ 37	30 23	332 3136	12.32 1.00	< 0.0001	30 12	163 3260	50.00 1.00	< 0.0001
Apgar (1^st min)
< 7 ≥ 7	34 19	171 3297	34.50 1.00	< 0.0001	22 20	127 3296	28.55 1.00	< 0.0001
Apgar (5^th min)
< 7 ≥ 7	26 27	25 3443	132.6 1.00	< 0.0001	18 25	18 3405	136.20 1.00	< 0.0001
Race
White Others	46 07	3130 338	1.00 1.41	0.4002	35 07	3243 180	1.00 3.60	0.0011
Assistance variables
Type of delivery
Vaginal Cesarean	36 17	1724 1744	2.14 1.00	0.0084	18 24	484 2939	4.55 1.00	< 0.0001
No. of prenatal consultations
< 7 ≥ 7	39 14	1461 2007	3.83 1.00	< 0.0001	29 13	994 2429	5.45 1.00	< 0.0001

Variable	2000 - 2002				2009-2011
Variable	Death (n=53)	Live (n=3468)	Adjusted Oddis Ratio	p-value	Death (n=42)	Live (n=3423)	Adjusted Oddis Ratio	p-value
Maternal variables
Level of education (years)
Up to 7	35	1476	2.73	< 0.0001	13	504	2.98	< 0.0001
8 or more	18	1992	1.00	< 0.0001	29	2919	1.00	< 0.0001
Type of gestation
Single	38	3398	1.00	<0.0001	39	3381	1.00	<0.0001
Multiple	15	70	11.34	<0.0001	03	42	6.83	<0.0001
Newborn variables
Birth weight (g)
< 2500	34	366	17.76	<0.0001	31	331	31.44	<0.0001
≥ 2500	19	3102	1.00	<0.0001	11	3092	1.00	<0.0001
Duration of gestation (weeks)
≤ 36	30	332	12.32	<0.0001	30	163	11.08	< 00001
37 to 41	23	3136	1.00		12	3260	1.00	< 00001
Apgar (^1st min)
0 to 6	34	171	8.88	<0.0001	22	127	6.87	<0.0001
7 to 10	19	3297	1.00	<0.0001	20	3296	1.00	<0.0001
Apgar (5^th min)
0 to 6	26	25	18.98	<0.0001	18	18	25.67	<0.0001
7 to 10	27	3443	1.00	<0.0001	25	3405	1.00	<0.0001
Assistance variables
No. of prenatal consultations
0 to 6	39	1461	1.86	< 0.0001	29	994	2.45	< 0.0001
≥ 7	14	2007	1.00		13	2429	1.00	< 0.0001

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Anna Lúcia da Silva 7601 Avenue, 8735, Block 37, Orleans, Vilhena, RO, Brazil. Zip Code: 76980-000annalubarbirato@unipar.br