Mortalidade e Near Miss Neonatal no Estado da Bahia, Brasil

Abstract

BACKGROUND: Regarding the components of infant mortality, neonatal mortality has shown a slight decrease over the years, constituting a public health problem. In addition to death, the Near Miss Neonatal (NMN) indicator includes newborns who have experienced almost fatal adverse events but have survived the neonatal period. In this sense, health surveillance should be an ally in addressing unfavorable outcomes. OBJECTIVE: Analyze neonatal mortality rates in the state of Bahia (study I) and analyze the rates of Neonatal Near Miss (NMN) and its determinants in the state of Bahia (study II). METHODS: The first study consisted of time series of neonatal deaths (n=2,246,730), an ecological study, that occurred in the state of Bahia (2010 to 2020), data available in DATASUS. Neonatal mortality rates and distribution were calculated according to sociodemographic, obstetric, newborn, and birth characteristics, as well as causes of death. Jointpoint regression analyses were adopted to calculate trends and annual percent change (APC). The second study consisted of a retrospective cohort of live births (n=1,821,384), in the state of Bahia (2012-2020), data from SINASC. NMN was defined as: gestational age < 32 weeks; birth weight < 1,500 grams; Apgar score < 7 at the fifth minute, and congenital malformation. Logistic regression models were adjusted to analyze factors associated with NMN. RESULTS: In Study I, a decreasing trend in neonatal mortality rates (APC: -1.9, p-value: < 0.001) and early neonatal mortality rates (APC: -2.2, p-value: < 0.001) was observed, while late neonatal mortality rates remained stable. Higher frequencies of neonatal deaths occurred among: mothers aged 20 to 34 years; with 8 to 11 years of education; single pregnancies; premature births; vaginal deliveries; male infants; non-white race/ethnicity; low birth weight; and among those with perinatal conditions and congenital malformations. A decreasing trend in neonatal mortality for causes that can be prevented through adequate prenatal and childbirth care was observed. However, an increasing trend was observed for congenital syphilis. In Study II, 55,285 cases were identified, resulting in a neonatal mortality rate of 3.0 per 1,000 live births. The factors associated with higher neonatal mortality rates in this study included male gender, maternal age (of 10 to 19 years or 35 years and older), and maternal education level (of 0 to 7 years or 8 to 11 years), not having a partner, having one or more fetal losses/abortions, multiple pregnancies, having fewer than 6 prenatal visits, not having an induced delivery, having a cesarean delivery, and non-cephalic fetal presentation were positively associated with NMN. Being a primipara, having had one or more previous normal deliveries, and having one or more previous cesarean deliveries were negatively associated with NMN. CONCLUSIONS: The morbidity and mortality of the studied population were associated with sociodemographic conditions as well as healthcare provision. Therefore, the challenge of reducing social inequities needs to be one of the main structuring axes to support the improvement of maternal and child health care pathways.