Annual trend of neonatal mortality and its underlying causes: population-based study - São Paulo State, Brazil, 2004-2013.

BACKGROUND: Population-based studies analyzing neonatal deaths in middle-income countries may contribute to design interventions to achieve the Sustainable Development Goals, established by United Nations. This study goal is to analyze the annual trend of neonatal mortality in São Paulo State, Brazil, over a 10-year period and its underlying causes and to identify maternal and neonatal characteristics at birth associated with neonatal mortality. METHOD: A population-based study of births and deaths from 0 to 27 days between 2004 and 2013 in São Paulo State, Brazil, was performed. The annual trend of neonatal mortality rate according to gestational age was analyzed by Poisson or by Negative Binomial Regression models. Basic causes of neonatal death were classified according to ICD-10. Association of maternal demographic variables (block 1), prenatal and delivery care variables (block 2), and neonatal characteristics at birth (block 3) with neonatal mortality was evaluated by Poisson regression analysis adjusted by year of birth. RESULTS: Among 6,056,883 live births in São Paulo State during the study period, 48,309 died from 0 to 27 days (neonatal mortality rate: 8.0/1,000 live births). For the whole group and for infants with gestational age 22-27, 28-31, 32-36, 37-41 and ≥ 42 weeks, reduction of neonatal mortality rate was, respectively, 18 %, 15 %, 38 %, 53 %, 31 %, and 58 %. Median time until 50 % of deaths occurred was 3 days. Main basic causes of death were respiratory disorders (25 %), malformations (20 %), infections (17 %), and perinatal asphyxia (7 %). Variables independently associated with neonatal deaths were maternal schooling, prenatal care, parity, newborn sex, 1st minute Apgar, and malformations. Cesarean delivery, compared to vaginal, was protective against neonatal mortality for infants at 22-31 weeks, but it was a risk factor for those with 32-41 weeks. CONCLUSIONS: Despite the significant decrease in neonatal mortality rate over the 10-year period in São Paulo State, improved access to qualified health care is needed in order to avoid preventable neonatal deaths and increase survival of infants that need more complex levels of assistance.

Temporal Trend, Causes, and Timing of Neonatal Mortality of Moderate and Late Preterm Infants in São Paulo State, Brazil: A Population-Based Study.

Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7-366/7 weeks gestation without congenital anomalies from 2004-2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7-366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais-Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.

Fatores que interferem no reconhecimento por adultos da expressão facial de dor no recém-nascido / Factors that interfere in the recognition of the neonatal facial expression of pain by adults

OBJETIVO:Avaliar quais fatores relacionados ao observador adulto interferem no reconhecimento da expressão facial de dor do recém-nascido a termo. MÉTODOS: Foram entrevistados 405 indivíduos (191 profissionais da área da saúde da criança e 214 pais/mães de recém-nascidos), pesquisando-se características pessoais, profissionais e socioeconômicas. Ao término da entrevista, cada indivíduo observou três séries de fotos de três bebês diferentes, cada série com oito fotos da face de cada neonato em oito tempos diferentes (T1, T3, T6 e T8: repouso; T2: estímulo luminoso; T4 e T5: fricção do calcâneo; T7: punção) e respondeu à seguinte pergunta: em qual foto desta prancha o senhor acha que o bebê está sentindo dor? Os 405 entrevistados foram analisados de acordo com número de acertos para as três séries de fotos por regressão linear múltipla. RESULTADOS: Constatou-se um menor número de acertos para os entrevistados sem parceiro fixo, com maior número de filhos, renda per capita elevada, atuação profissional na área da saúde e escolaridade inferior a 16 anos ou com atuação profissional em outras áreas que não a da saúde e escolaridade superior a 16 anos. Ou seja, os entrevistados detentores dessas características tiveram maior dificuldade para reconhecer a expressão facial de dor do recém-nascido. CONCLUSÕES: Diante da heterogeneidade dos fatores que interferem no reconhecimento da expressão facial de dor no recém-nascido por observadores adultos aqui encontrada, faz-se necessária a utilização rotineira de instrumentos objetivos para a avaliação sistemática da dor no período neonatal.

OBJECTIVE:To evaluate the factors related to adult observers that interfere on their recognition of facial expression of pain in term newborn infants. METHODS:405 adults were interviewed: 191 health professionals and 214 parents. Adults' demographic and socio-economical characteristics were surveyed. At the end of the interview, each adult looked at three series of pictures of three different newborns, each series with eight pictures of the face of each newborn, in eight different moments (M1, M3, M6 e M8: resting; M2: light stimulus; M4 and M5: heel rubbing; M7: heel stick) and answered to the following question: In which picture of these do you think the newborn is feeling pain? The 405 adults were analyzed according to the number of right answers for the three series of pictures by multiple linear regression analysis. RESULTS:A smaller number of right answers in the three series of pictures was noticed to adults without a partner, with more children, higher family income and, if health professionals, with less years in school or, if parents, with more years in school. Adults with these characteristics, therefore, presented more difficulty to recognize the expression of pain in the newborn's face. CONCLUSIONS:The heterogeneity of factors that interfere in the recognition of neonatal pain by adults emphasizes the need of using validated pain assessment tools in the care of critically ill neonates.

Aplicaçäo das escalas comportamentais para a avaliacao da dor em recem-nascidos / Behavioral pain scales assessment in neonates

Objetivos: Avaliar a sensibilidade e a especifidade de duas escalas comportamentais de dor em recém-nascidos (RN) de diferentes idades gestacionais (IG). Método: 133 recém-nascidos estáveis, com menos de 72h de vida, sem alteraçöes do SNC ou uso de analgesia/sedaçäo e com Apgar aos 5'>7 foram sorteados para receber punçäo capilar - P, ou nfricçäo de pele - F.Os recém-nascidos foram divididos de acordo com a IG (28-33 sem.=A; 34-37 sem.=B; 38-41 sem.=C) e com o procedimento (P/F): grupo A-P (n=17, 1,5+-0,4kg); A-F (n=18, 1,5+-0,4kg); B-P (n=25, 2,5+-0,5kg); B-F (n=25,2,4+-0,6kg); C-P (n=23, 3,3kg+-0,5kg); C-F (n=25; 3,3+-0,4kg). Um neonatologista, cego em relaçäo a P ouF, avaliou duas escalas de dor: NFCS (o-8 pontos, dor > 3) e NIPS (0-7 pontos, dor > 3). Todas as avaliaçöes foram realizadas antes de P/F (Pr), no aquecimento do pé (a), durante (0), 1' e 3' após P ou F...