Factors associated with neonatal near miss in a Midwest capital in Brazil

observational cohort study of live births from Cuiabá in the period of 2015 to 2018, with data from the Sistemas de Informações sobre Mortalidade e sobre Nascidos Vivos (Mortality and Live Birth Information Systems). The neonatal near miss rate was calculated according to sociodemographic, obstetric, childbirth, and neonate variables. Logistic regression model was adjusted to analyze the factors associated with neonatal near miss.

Results:

the neonatal near miss rate was 22.8 per thousand live births and the variables showed an association with the outcome were: maternal age 35 years or older (OR=1.53; CI95%=1.17-2.00), having fewer than six prenatal consultations (OR=2.43; CI95%=2.08-2.86), non-cephalic fetal presentation (OR=3.09; CI95%=2.44-3.92), multiple pregnancy (OR=3.30; CI95%=2.57- 4.23), no live birth (OR=1.62; CI95%=1.34-1.96) or one live birth (OR=1.22; CI95%=1.00-1.48), delivery in public/university hospital (OR=2.16; CI95%=1.73-2.71) and philanthropic hospital (OR=1.51; CI95%=1.19-1.91) and non-induced labor (OR=1.50; CI95%=1.25-1.80).

Conclusion:

the neonatal near miss rate was 3.04 cases for each death, and neonatal near miss was influenced by maternal characteristics, obstetric history, type of birth hospital, and delivery care organization.

Key words:
Vital statistics; Near miss; Information system; Morbidity; Newborn

Criteria combination	Number of neonates	%
Total live births in Cuiabá	40.741	100.0
Total infant deaths (under 1 year old)	427	1.05
Total neonatal deaths period	306	0.75
Total deaths in the early neonatal period	202	0.49
Total deaths in the late neonatal period	104	0.25
Total newborns classified as NNM	931	2.28
Pre-term (<37 weeks)	4.457	10.94
Term (37 to 42 weeks)	36.139	88.70
Post-term (>42 weeks)	56	0.14
Pragmatic criteria GA <32 weeks*	400	0.98
Extremely low birth weight (<1.000g)	274	0.67
Very low birth weight (1.000 to <1.500g)	288	0.70
Low birth weight (1.500 to <.2.500g)	3.002	7.37
Adequate weight (2.500 to <4.000g)	35.180	86.35
Fetal macrosomia (4.000g or more)	1.997	4.90
Pragmatic criterion birth weight <1.500g	379	0.93
Pragmatic criterion for congenital malformation	187	0.46
Pragmatic criterion Apgar score < 7 in the fifth minute**	260	0.64
Neonatal near miss rate	22.8/1.000 NB	-
Infant mortality rate	10.48 /1.000 NB	-
Neonatal mortality rate	7.5/1.000 NB	-
Late neonatal mortality rate	2.5/1.000 NB	-
Early neonatal mortality rate	5.0/1.000 NB	-
Severe neonatal outcome rate	30.4/1.000 NB	-

Variables	Live births (40.741)		Neonatal near miss (931)		p^#
Variables	n*	%	NNM Rate*	CI95%	p^#
Socioeconomic and demographic
Mother’s age (years)
10 - 19	5.674	13.93	23.60	19.97; 27.91	<0.001
20 - 34	29.403	72.17	21.40	19.76; 23.07
35 or more	5.664	13.90	29.80	25.72;34,60
Schooling^a (Years of study)
0 to 8	5.827	14.30	29.00	24.99; 33.64	0.003
9 to 11	21.241	52.14	21.56	19.69; 23.60
12 or more	13.603	33.39	22.05	19.72; 24.66
Race/Color^b
White	8.660	21.26	24.02	21.00; 27.46
Black	2.461	6.04	24.79	19.33; 31.76
Yellow and indigenous	165	0.40	12.12	3.02; 47.34	0.523
Mixed	29.337	72.01	22.26	20.63; 24.01
Marital status^c
Without partner	15.250	37.50	26.49	24.06; 29.16	<0.001
With partner	25.422	62.40	20.53	18.86; 22.35
Working^d
No	19.372	47.66	23.38	21.35; 25.61	0.437
Yes	21.275	52.34	22.23	20.34; 24.30
Newborns
Sex^e
Female	19.931	48.92	21.42	19.50; 23.53
Male	20.807	51.07	24.13	22.13; 26.30	0,068

Variables	Live births (40.741)		Neonatal Near Miss (931)		p ^#
Variables	n*	%	NNM Rate **	CI95% *	p ^#
Obstetrics and childbirth
Quarter that started prenatal^f
First	32.229	80.34	22.37	20.81; 24.04
Second	6.454	16.09	24.17	20.69; 28.22	0.620
Third	1.151	2.87	20.85	14.01; 30.93
Number of prenatal consultations^g
<6	6.506	16.00	42.42	37.79; 47.60	<0.001
≥6	34.116	83.92	18.96	17.57; 20.47
Number of pregnancies^h
Nulliparous	15.224	37,87	24.11	21.79; 26.67
Primiparous	12.472	31.02	22.05	19.61; 24.78	0.231
Second	6.909	17.18	20.26	17.19; 23.87
Multiparous	5.600	13.93	24.64	20.89; 29.05
Number of normal childbirthsⁱ
0	26.385	65,63	22.85	21.12; 24.73
1	7.618	18,95	22.18	19.11; 25.74	0.801
2 or more	6.197	15,42	23.88	20.36; 27.99
Number of cesarean deliveries^j
0	27.843	69.26	23.99	22.26;25.86
1	8.996	22.38	21.90	19.07; 25.14	0.021
2 or more	3.364	8.37	16.65	12.83; 21.57
Number of children born alive^k
0	17.117	42.59	25.00	22.77; 27.45
1	13.168	32.77	21.49	19.15; 24.11	0.042
2 or more	9.904	24.64	20.90	18.26; 23.91
Number of fetal loss, miscarriages^l
0	32.580	81.22	21.88	20.35; 23.53
1	6.052	15.09	25.12	21.46; 29.37	0.003
2 or more	1.483	3.70	34.39	26.23; 44.98
Type of Hospital^m
Private linked to SUS	21.651	53.36	17.04	15.40; 18.86
Private	11.173	27.54	21.39	18.87; 24.25	<0.001
Philanthropic	4.389	10.82	31.90	27.09; 37.53
Public/University	3.359	8.28	49.12	42.31; 56.97
Fetal presentationⁿ
Cephalic	39.411	96.74	20.40	19.05; 21.84	<0.001
Non cephalic	1.126	2.76	95.03	79.22; 113.60
Type of pregnancies^o
Single	39.737	97.57	2071	19.36; 22.16	<0.001
Double or more	988	2.43	108.30	90.38;129.27
Induced labor^p
Yes	9.768	24.11	15.66	13.38; 18.33	<0.001
No	30.605	75.55	25.13	23.43; 26.94
Type of childbirth^q
Vaginal	18.031	44.26	21.52	19.50; 23.74	0.107
Cesarean	22.696	55.71	23.92	22.02; 26.00
Professional who assisted the childbirth^r
Physician	40.360	99.10	22.70	21.29; 24.20	0.070
Non physician	349	0.86	37.25	21.73; 63.13

Variable	OR	CI95%	p
Mother’s age (years)
10 - 19	1.00	-
20 - 34	1.08	0.87; 1.33	0.47
35 or more	1.53	1.17; 2.00	0.002
Number of children born alive
0	1.62	1.34; 1.96	<0.001
1	1.22	1.00; 1.48	0.043
2 or more	1.00	-
Type of pregnancy
Single	1.00	-
Double or more	3.30	2.57; 4.23	<0.001
Number of prenatal consultations
<6	2.43	2.08; 2.86	<0.001
≥6	1.00	-
Type of Hospital
Private	1.00	-
Private linked to SUS	0.90	0.75; 1.09	0.294
Public/University	2.16	1.73; 2.71	<0.001
Philantropic	1.51	1.19; 1.91	0.001
Fetal presentation
Cephalic	1.00	-
Non cephalic	3.09	2.44; 3.92	<0.001
Induced labor
No	1.50	1.25;1.80	<0.001
Yes	1.00	-

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[1] Associated Editor: Samir Kassar