OBJECTIVE: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. METHODS: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. RESULTS: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth. CONCLUSION: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.
OBJECTIVE: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. METHODS: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. RESULTS: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth. CONCLUSION: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.
Authors: Brandon W Alleman; Edward F Bell; Lei Li; John M Dagle; P Brian Smith; Namasivayam Ambalavanan; Matthew M Laughon; Barbara J Stoll; Ronald N Goldberg; Waldemar A Carlo; Jeffrey C Murray; C Michael Cotten; Seetha Shankaran; Michele C Walsh; Abbot R Laptook; Dan L Ellsbury; Ellen C Hale; Nancy S Newman; Dennis D Wallace; Abhik Das; Rosemary D Higgins Journal: Pediatrics Date: 2013-06-10 Impact factor: 7.124
Authors: Paula Maria Silveira Soares Moura; Izildinha Maestá; Lígia Maria Souza Suppo Rugolo; Luís Felipe Ramos Berbel Angulski; Antônio Prates Caldeira; José Carlos Peraçoli; Marilza Vieira Cunha Rudge Journal: Reprod Health Date: 2014-01-30 Impact factor: 3.223
Authors: W A Gonçalves-Ferri; F E Martinez; J P S Caldas; S T M Marba; S Fekete; L Rugolo; C Tanuri; C Leone; G A Sancho; M F B Almeida; R Guinsburg Journal: Braz J Med Biol Res Date: 2014-01-29 Impact factor: 2.590