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DOI: 10.1055/s-0042-1754410
Temporal Trend and Risk Factors for Respiratory Distress Syndrome–Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country
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.
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
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RDS is associated with preterm live births.
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Impact of RDS-associated neonatal mortality in middle-income countries is scarce.
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Qualified perinatal care can reduce RDS-associated neonatal mortality.
Keywords
infant - premature - respiratory distress syndrome - newborn - neonatal mortality - epidemiological studies - factors - riskPublication 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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