Factors associated with neonatal near miss in Brazil.

OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

Factors associated with neonatal near miss in Brazil / Fatores associados ao near miss neonatal no Brasil

ABSTRACT OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

RESUMO OBJETIVO: Este estudo avalia a associação entre fatores sociodemográficos, características maternas, organização dos serviços de saúde e near miss neonatal em maternidades públicas e privadas do Brasil. MÉTODOS: Trata-se de uma coorte prospectiva de nascidos vivos da pesquisa Nascer no Brasil, realizada entre 2011 e 2012. As variáveis foram estabelecidas a partir da literatura e organizadas em três níveis: distal, intermediário e proximal. A avaliação foi realizada a partir dos resultados das análises bivariadas e de seus respectivos valores-p, com nível de significância < 0,20, pelo teste de Wald. Para a análise multivariada, foram inseridas as variáveis contidas no nível distal, conservadas no modelo quando significativas (p < 0,05). O mesmo foi feito no ajuste dos níveis intermediário e proximal. RESULTADOS: No nível distal, nenhuma variável apresentou associação significativa com o desfecho. No nível intermediário, idade da mãe maior ou igual a 35 anos (risco relativo - RR = 1,32; IC95% 1,04-1,66), parto cesáreo (RR = 1,34; IC95% 1,07-1,67), uso de fumo (RR = 1,48; IC95% 1,04-2,10), síndrome hipertensiva gestacional (RR = 2,29; IC95% 1,98-3,14), diabetes pré-gestacional (RR = 2,63; IC95% 1,36-5,05) e gestação gemelar (RR = 2,98; IC95% 1,90-4,68) foram variáveis associadas ao desfecho. No nível proximal, o pré-natal não adequado (RR = 1,71; IC95% 1,36-2,16) e a localização do hospital/maternidade na capital (RR = 1,89; IC95% 1,40-2,55) foram associados ao near miss neonatal. CONCLUSÃO: Os resultados mostram que o near miss neonatal foi influenciado pelas variáveis da organização dos serviços de saúde e pelas características maternas.