TITLE: Neonatal mortality and periviability in very low birth weight preterm infants
ABSTRACT
The preterm birth is currently one of the main public health issues. The frequency of this condition has grown worldwide, especially in the developing nations. This is the case of Brazil, which is among the ten countries with the highest numbers of premature births. Furthermore, the prematurity is the leading cause of mortality in infants under five years old and is responsible for the increase of short and long terms morbidities. Thereby, epidemiological studies are fundamental to understand this condition, its determinants and related risk factors. Objective: to assess the mortality and periviability of premature and very low birth weight newborns. Methods: analytical cross-section study with retrospective data collection from medical charts of 627 premature infants under 32 completed weeks of gestational age (GA) and birth weight (BW) under 1500 grams admitted to the neonatal intensive care unit (NICU) of a single Brazilian tertiary hospital between August 2008 and August 2018. For all statistical tests, we considered a 5% level of significance. Results: The average GA was 27.9 ± 2.5 weeks and the average BW was 964.8 ± 287 grams. The death rate was 26.6% and the periviability was 25 weeks. Most deaths (39.5%) occurred in the first week of life, 29.3% occurred in the first 24 hours and 86,8% in the neonatal period. The mortality rate was significantly higher in the following groups (p < 0.05): neonatal resuscitation in the delivery room (OR: 2,19), early neonatal sepsis (OR: 2,45), respiratory distress syndrome (RDS) (OR: 5,61) and peri-intraventricular haemorrhage (PIVH) (OR: 3,04). The median BW among who died was 715g (567,5; 877,5) whereas it was 1035g (850; 1255) among who survived (p < 0,001). Furthermore, the reduction of BW significantly increased death rate, which was 88,5% with BW < 500g and 8,3% with BW ? 1250g (p < 0,001). The increase in GA also reduced mortality, which was 43,7% with GA < 28 weeks and 11,4% with GA ? 28 weeks (p < 0,001). Protective factors in this study were (p < 0,05): female gender (OR: 0,65), GA ? 28 weeks (OR: 0,16), continuous positive airway pressure (CPAP) in the delivery room (OR: 0,31) and use of inhaled O2 during neonatal resuscitation (OR: 0,24). Conclusion: The preterm birth leads to a higher risk to neonatal death. The mortality among very and extremely low birth weight prematures is inversely proportional to GA and BW. This risk increases in the presence of worse birth conditions and conditions that require neonatal resuscitation. Besides, the presence of comorbidities increases mortality, with RDS, PIVH and neonatal sepsis being the main ones found in this study. Assessing this population characteristics is fundamental to uncover modifiable determinants that may be increasing mortality. Therefore, epidemiological studies are important to improve the preterm newborn medical care quality and stablish knowledge to offer more ways to survive in better conditions.
KEYWORDS: Premature infant; mortality; very low birth weight infant
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