Neonatal <i>near miss</i> and the occurrence of negative outcomes in the first year of life: data from a national survey, <i>Nascer no Brasil</i> (Born in Brazil), 2011-2012

Kale, Pauline Lorena; Fonseca, Sandra Costa; Gama, Silvana Granado Nogueira

doi:10.1590/1806-93042020000300007

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 20 (3) • Jul-Sep 2020 • https://doi.org/10.1590/1806-93042020000300007 copy

Neonatal near miss and the occurrence of negative outcomes in the first year of life: data from a national survey, Nascer no Brasil (Born in Brazil), 2011-2012

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

estimate the strength of association between neonatal near miss and the nega-tive outcomes in the child’s first year of life.

Methods:

a prospective cohort study on neonatal survivors originating from a national survey “Nascer no Brasil (Born in Brazil), 2011-2012.” Main exposure: neonatal near miss (NNM). Negative outcomes: breastfeeding, hospitalization, and post neonatal death (tele-phone interview). For each outcome, the odds ratio (OR) were estimated by univariate (p<0.2) and multivariate (p<0.05) logistic regression models.

Results:

among 15,675 children 3.3% were neonatal near miss. Neonatal near miss was associated, after adjusting, to: weaning (OR=1.8); hospitalization after hospital discharge (OR=2.2); remained hospitalized (OR=65.6) and post neonatal death (OR=52.4) The increased OR after adjusting revealed negative confounding, such as “remained hospitalized since childbirth” (OR_crude=21.1 and OR_adjusted=65.6).

Conclusions:

although neonatal near miss reflects a good quality of health care, avoiding neonatal death, these survivors have higher risk of negative outcomes in the first year of life.

Key words:
Near miss; Infant mortality; Hospitalization; Breastfeeding

Variables	n (unweighted)^* * Not all the totals are equal due to the ignored information;	% losses on follow-up (weighted)	p ^ Pearson's chi-square test.
Main Exposure
Near Miss			0.586
yes	762	31.4
no	22,392	32.3
Geographic
Region			<0.001
North	2,805	47.2
Northeast	5,935	45.6
Southeast	7,861	26.7
South	4,055	15.7
Midwest	2,722	29.9
Hospital location			<0.001
capital	7,370	27.4
countryside	16,008	34.7
Maternal
Age group (years)			<0.001
<20	4,240	39.5
20-34	16,552	31.0
≥35	2,582	29.6
Skin color
white	8,407	25.6	<0.001
black	1,816	37.5
mixed	12,798	36.1
Paid work
yes	9,934	25.3	<0.001
no	13,441	37.7
Schooling
incomplete elementary school	5,814	48.6	<0.001
complete elementary school	5,607	32.2
high school	9,141	24.9
higher education or more	2,712	22.7
Economic status			<0.001
Upper class (A+B)	6,540	21.7
Middle class (C)	11,391	28.6
Lower class (D+E)	5,229	53.4
Marital Status			0.009
With a partner	4,000	34.2
Without a partner	19,365	32.0
Primiparity			<0.001
yes	10,930	29.8
no	12,447	34.8
Smoking			0.007
yes	3,688	34.3
no	19,676	32.1
Consumption of alcohol			<0.001
no	19,872	32.9
non-abusive alcohol consume	852	24.4
abusive alcohol consume	2,108	30.6

Variables	Did not breastfeed yesterday/today			Hospitalization after discharge of childbirth			Remain hospitalized			Post neonatal death
Variables	OR	CI95%	p	OR	CI95%	p	OR	CI95%	p	OR	CI95%	p
Main Exposure
Near Miss			<0.001			0.131			<0.001			<0.001
yes	1.67	1.31-2.14		2.14	1.45-3.14		21.133	6.82-65.5		51.41	22.45-117.7
no	1			1			1			1
Geographic
Region			<0.001			0.006			0.044			0.055
North	0.34	0.24- 0.48		0.67	0.47-0.95		9.30	1.96-44.0		0.34	0.04-2.64
Northeast	0.85	0.65- 1.11		0.65	0.48-0.89		8.05	1.30-49.9		1.25	0.41-3.77
Southeast	0.78	0.64-0.95		0.63	0.49-0;81		7.33	1.81-29.6		0.35	0.11-1.08
South	1			1			1			1
Midwest	0.55	0.43-0.71		0.74	0.49-1.10		4.76	0.96-23.5
Hospital location			0.161			0.906			0.172			0.187
capital	1			1			1			1
countryside	1.15	0.95-1.39		1.01	0.83-1.24		0.46	0.15-1.41		0.55	0.23-1.33
Maternal
Age group (years)			0.057			0.667			0.853			0.446
<20	0.90	0.76-1.07		1.11	0.88-1.40		1.07	0.36-3.19		1.65	0.64-4.23
20-34	1			1			1			1
≥35	1.25	0.97-1.62		0.98	0.72-1.34		0.75	0.21-2.60		0.64	0.14-2.95
Skin color			<0.001			0.028			0.697			0.405
white	1			1			1			1
black	0.88	0.60-1.30		0.83	0.61-1.14		1.06	0.14-8.05		0.90	0.20-4.05
mixed	0.75	0.65-0.86		0.77	0.63-0.93		1.49	0.58-3.81		0.57	0.25-1.32
Paid work			0.006			0.648			0.154			0.702
yes	1			0.95	0.78-1.17		1.93	0.78-4.78		1.18	0.50-2.80
no	0.85	0.76-0.95		1			1			1
Schooling			0.173			0.280			0.192			0.623
incomplete elementary school	0.92	0.67-1.16		0.98	0.69-1.40		1.31	0.39-4.39		0.96	0.23-4.10
complete elementary school	0.76	0.56-1.04		1.18	0.87-1.62		2.79	0.73-10.7		0.47	0.12-1.86
high school	0.88	0.67-1.16		0.94	0.68-1.28		0.81	0.24-2.70		0.85	0.25-2.80
higher education or more	1			1			1			1
Economic status			0.007			0.729			0.062			0.383
Upper class (A+B)	1			1			1			1
Middle class (C)	0.76	0.62-0.93		1.09	0.88-1.35		2.55	0.92-7.06		0.69	0.28-1.72
Lower class (D+E)	0.71	0.56-0.90		1.05	0.80-1.39		0.71	0.25-2.01		1.44	0.48-4.30
Marital status			<0.001			0.822			0.921			0.298
With a partner	1.17	0.98-1.41		0.97	0.75-1.25		1.05	0.41-2.72		0.57	0.20-1.65
Without a partner	1			1			1			1
Primiparity			0.007			0.219			0.479			0.087
yes	1			1			1			1
no	0.80	0.69-0.94		1.13	0.93-1.38		1.41	0.54-3.67		0.49	0.22-1.11
Smoking			0.028			0.991			0.179			0.746
yes	1.20	1.02-1.41		1.00	0.79-1.27		2.74	0.63-11.9		0.85	0.32-2.26
no	1			1			1			1
Consumption of alcohol			0.802			0.108			0.221			<0.001
no	1			1			1			1
non-suspected of heavy	1.04	0.74-1.48		1.10	0.72-1.68		0.69	0.09-5.25		0.00	0.00-0.00
Suspected of heavy consume	1.09	0.85-1.39		0.73	0.52-1.01		3.97	0.80-19.69		1.34	0.37-4.93

Outcomes / Models	OR	CI95%	p
1.No breastfeeding yesterday until today
Model 1.1	1.7	1.3 - 2.2	<0.001
Model 1.2	1.8	1.4 - 2.3	<0.001
2. Hospitalization after discharge of childbirth
Model 2.1	2.2	1.5 - 3.2	<0.001
Model 2.2	2.2	1.5 - 3.3	<0.001
3. Remained hospitalized since childbirth
Model 3.1	64.5	23.5 - 177.4	<0.001
Model 3.2	65.6	24.1 - 178.5	<0.001
4. Post neonatal death
Model 4.1	51.4	22.5 - 117.2	<0.001
Model 4.2	52.4	22.8 - 120.3	<0.001

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] Authors’ contribution

Kale PL, Gama SGN and Fonseca SC participated in the conception and initial writing of the manuscript. All the authors participated of the analysis of data and interpretation of the results and in the review and final approval of the manuscript.