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CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(S 01): e298-e304
DOI: 10.1055/s-0042-1754410
Original Article

Temporal Trend and Risk Factors for Respiratory Distress Syndrome–Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country

Ana Sílvia Scavacini Marinonio 
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Daniela Testoni Costa-Nobre
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Adriana Sanudo
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Milton Harumi Miyoshi
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Kelsy Catherina Nema Areco
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Mandira Daripa Kawakami
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Rita de Cassia Xavier
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Tulio Konstantyner
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Paulo Bandiera-Paiva
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Rosa Maria Vieira de Freitas
2   Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), São Paulo, São Paulo, Brazil
,
Lilian Cristina Correia Morais
2   Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), São Paulo, São Paulo, Brazil
,
Mônica La Porte Teixeira
2   Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), São Paulo, São Paulo, Brazil
,
Bernadette Cunha Waldvogel
2   Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), São Paulo, São Paulo, Brazil
,
Carlos Roberto Veiga Kiffer
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Maria Fernanda Branco de Almeida
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
,
Ruth Guinsburg
1   Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
› Author Affiliations Funding This research was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Project number 2017/03748-7; however, it has no role in any step of the study and report (including study design, analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication), which was authors' responsibility.
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Abstract

Objective This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths.

Study Design This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais–Winsten. Kaplan–Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI.

Results A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: −6.50%; 95% CI: −9.11 to −3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09–1.29), zero to three prenatal care visits (1.25; 1.18–1.32), multiple pregnancy (1.24; 1.16–1.33), vaginal delivery (1.29; 1.22–1.36), GA 22 to 27 weeks (106.35; 98.36–114.98), GA 28 to 31 weeks (20.12; 18.62–21.73), male sex (1.16; 1.10–1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08–7.47) and 4 to 6 (3.97; 3.72–4.23).

Conclusion During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants.

Key Points

  • RDS is associated with preterm live births.

  • Impact of RDS-associated neonatal mortality in middle-income countries is scarce.

  • Qualified perinatal care can reduce RDS-associated neonatal mortality.

Keywords

infant - premature - respiratory distress syndrome - newborn - neonatal mortality - epidemiological studies - factors - risk

Supplementary Material



Publication History

Received: 05 December 2021

Accepted: 01 June 2022

Article published online:
16 August 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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