Neonatal mortality by gestational age in days in infants born at term: A cohort study in Sao Paulo city, Brazil

Marcel Reis Queiroz; Maria Elizangela Ramos Junqueira; Alejandra Andrea Roman Lay; Eliana de Aquino Bonilha; Mariane Furtado Borba; Célia Maria Castex Aly; Roberto Aparecido Moreira; Carmen Simone Grilo Diniz

doi:10.1371/journal.pone.0277833

Neonatal mortality by gestational age in days in infants born at term: A cohort study in Sao Paulo city, Brazil

Título traducido de la contribución: Mortalidad neonatal según edad gestacional en días en recién nacidos a término: Un estudio de cohorte en la ciudad de São Paulo, Brasil

Marcel Reis Queiroz
, Maria Elizangela Ramos Junqueira
, Alejandra Andrea Roman Lay
, Eliana de Aquino Bonilha
, Mariane Furtado Borba
, Célia Maria Castex Aly
, Roberto Aparecido Moreira
, Carmen Simone Grilo Diniz

Facultad de Ciencias de la Salud

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

1 Cita (Scopus)

Resumen

El nacimiento a término comprende un período con resultados neonatales heterogéneos que tienden a ser peores para los bebés nacidos prematuramente. Sin embargo, pocos estudios han analizado este período, en el que cada día puede marcar la diferencia. Por lo tanto, nuestro objetivo es evaluar la mortalidad neonatal (MN) según la edad gestacional (EG) al nacer medida en días en bebés nacidos vivos a término nacidos entre 2012 y 2017 en São Paulo, la ciudad más grande de América Latina. Este estudio de cohorte basado en la población evaluó a los bebés nacidos vivos a término seguidos hasta el final del período neonatal. Analizamos 7 modelos para la MN según la EG en días: MN cruda ajustada por variables maternas y prenatales, MN ajustada adicionalmente por tipo de nacimiento y tipo de hospital, y MN ajustada estratificada por tipo de nacimiento (cesárea y vaginal) y por tipo de hospital (público y privado). Incluimos 440.119 bebés vivos nacidos entre los 259 y 293 días de gestación. La mediana de EG al nacer fue de 274 días. En todos los modelos, la NM fue mayor en los lactantes nacidos a término prematuro, disminuyendo en los lactantes nacidos a término completo y aumentando de nuevo en los lactantes nacidos a término tardío. En el modelo sin ajustar, los cocientes de riesgo de NM cambiaron diariamente, disminuyendo de 3,34 a 1,00 el día 278 y aumentando de nuevo posteriormente. En el análisis estratificado según el tipo de hospital, nacer en un hospital público se asoció con un menor riesgo de NM en los lactantes nacidos entre los 278 y 283 días de gestación. Hubo una disminución de la EG relacionada con las intervenciones obstétricas, especialmente las cesáreas, que aumentaron la NM. La pérdida de días de gestación fue mayor en los hospitales privados. Aumentar la granularidad de la EG a días es factible y tiene el potencial de impulsar políticas públicas. Hasta donde sabemos, este es el primer estudio brasileño sobre la EG en días que utiliza una base de datos nacional de nacidos vivos.

Título traducido de la contribución	Mortalidad neonatal según edad gestacional en días en recién nacidos a término: Un estudio de cohorte en la ciudad de São Paulo, Brasil
Idioma original	Inglés
Número de artículo	e0277833
Publicación	PLoS ONE
Volumen	17
N.º	11 November
DOI	https://doi.org/10.1371/journal.pone.0277833
Estado	Publicada - nov. 2022

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title = "Neonatal mortality by gestational age in days in infants born at term: A cohort study in Sao Paulo city, Brazil",

abstract = "Birth at term comprises a period with heterogeneous neonatal outcomes that tend to be worse for infants born earlier. However, few studies have analyzed this period, in which each day can make a difference. Therefore, we aim to assess neonatal mortality (NM) according to gestational age (GA) at birth measured in days in term liveborn infants born in 2012-2017 in S{\~a}o Paulo, the largest city in Latin America. This population-based cohort study assessed term liveborn infants followed until the end of the neonatal period. We analyzed 7 models for NM according to GA in days: crude NM adjusted for maternal and prenatal variables, NM additionally adjusted for type of birth and type of hospital, and adjusted NM stratified by type of birth (cesarean and vaginal) and by type of hospital (public and private). We included 440, 119 live infants born at 259-293 days of gestation. The median GA at birth was 274 days. In all models, NM was higher for infants born early term, decreasing in infants born full term and rising again in infants born late term. In the unadjusted model, hazard ratios of NM changed daily, decreasing from 3.34 to 1.00 on day 278 and increasing again thereafter. In the stratified analysis according to type of hospital, being born in a public hospital was associated with a reduced risk of NM for infants born at 278-283 days of pregnancy. There was a decrease in GA related to obstetric interventions, especially cesarean sections, which increased NM. The loss of days of pregnancy was larger in private hospitals. Increasing the granularity of GA to days is feasible and has the potential to drive public policies. To the best of our knowledge, this is the first Brazilian study on GA in days using a national live births database.",

author = "Queiroz, \{Marcel Reis\} and Junqueira, \{Maria Elizangela Ramos\} and Lay, \{Alejandra Andrea Roman\} and \{de Aquino Bonilha\}, Eliana and Borba, \{Mariane Furtado\} and Aly, \{C{\'e}lia Maria Castex\} and Moreira, \{Roberto Aparecido\} and Diniz, \{Carmen Simone Grilo\}",

note = "Publisher Copyright: {\textcopyright} 2022 Reis Queiroz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2022",

month = nov,

doi = "10.1371/journal.pone.0277833",

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T1 - Neonatal mortality by gestational age in days in infants born at term

T2 - A cohort study in Sao Paulo city, Brazil

AU - Queiroz, Marcel Reis

AU - Junqueira, Maria Elizangela Ramos

AU - Lay, Alejandra Andrea Roman

AU - de Aquino Bonilha, Eliana

AU - Borba, Mariane Furtado

AU - Aly, Célia Maria Castex

AU - Moreira, Roberto Aparecido

AU - Diniz, Carmen Simone Grilo

N1 - Publisher Copyright: © 2022 Reis Queiroz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2022/11

Y1 - 2022/11

N2 - Birth at term comprises a period with heterogeneous neonatal outcomes that tend to be worse for infants born earlier. However, few studies have analyzed this period, in which each day can make a difference. Therefore, we aim to assess neonatal mortality (NM) according to gestational age (GA) at birth measured in days in term liveborn infants born in 2012-2017 in São Paulo, the largest city in Latin America. This population-based cohort study assessed term liveborn infants followed until the end of the neonatal period. We analyzed 7 models for NM according to GA in days: crude NM adjusted for maternal and prenatal variables, NM additionally adjusted for type of birth and type of hospital, and adjusted NM stratified by type of birth (cesarean and vaginal) and by type of hospital (public and private). We included 440, 119 live infants born at 259-293 days of gestation. The median GA at birth was 274 days. In all models, NM was higher for infants born early term, decreasing in infants born full term and rising again in infants born late term. In the unadjusted model, hazard ratios of NM changed daily, decreasing from 3.34 to 1.00 on day 278 and increasing again thereafter. In the stratified analysis according to type of hospital, being born in a public hospital was associated with a reduced risk of NM for infants born at 278-283 days of pregnancy. There was a decrease in GA related to obstetric interventions, especially cesarean sections, which increased NM. The loss of days of pregnancy was larger in private hospitals. Increasing the granularity of GA to days is feasible and has the potential to drive public policies. To the best of our knowledge, this is the first Brazilian study on GA in days using a national live births database.

AB - Birth at term comprises a period with heterogeneous neonatal outcomes that tend to be worse for infants born earlier. However, few studies have analyzed this period, in which each day can make a difference. Therefore, we aim to assess neonatal mortality (NM) according to gestational age (GA) at birth measured in days in term liveborn infants born in 2012-2017 in São Paulo, the largest city in Latin America. This population-based cohort study assessed term liveborn infants followed until the end of the neonatal period. We analyzed 7 models for NM according to GA in days: crude NM adjusted for maternal and prenatal variables, NM additionally adjusted for type of birth and type of hospital, and adjusted NM stratified by type of birth (cesarean and vaginal) and by type of hospital (public and private). We included 440, 119 live infants born at 259-293 days of gestation. The median GA at birth was 274 days. In all models, NM was higher for infants born early term, decreasing in infants born full term and rising again in infants born late term. In the unadjusted model, hazard ratios of NM changed daily, decreasing from 3.34 to 1.00 on day 278 and increasing again thereafter. In the stratified analysis according to type of hospital, being born in a public hospital was associated with a reduced risk of NM for infants born at 278-283 days of pregnancy. There was a decrease in GA related to obstetric interventions, especially cesarean sections, which increased NM. The loss of days of pregnancy was larger in private hospitals. Increasing the granularity of GA to days is feasible and has the potential to drive public policies. To the best of our knowledge, this is the first Brazilian study on GA in days using a national live births database.

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VL - 17

JO - PLoS ONE

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IS - 11 November

M1 - e0277833

ER -

Neonatal mortality by gestational age in days in infants born at term: A cohort study in Sao Paulo city, Brazil

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