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Sustainable Development Goals
03 Saúde e Bem-EstarCollections
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RISK OF MORTALITY FOR SMALL NEWBORNS IN BRAZIL, 2011-2018: A NATIONAL BIRTH COHORT STUDY OF 17.6 MILLION RECORDS FROM ROUTINE REGISTER-BASED LINKED DATA
Author
Paixão, Enny Santos da
Blencowe, Hannah
Falcao, Ila Rocha
Ohuma, Eric O.
Rocha, Aline dos Santos
Alves, Flávia Jôse Oliveira
Costa, Maria da Conceição Nascimento
Idueta, Lorena Suárez
Ortelan, Naiá
Smeeth, Liam
Rodrigues, Laura C.
Lawn, Joy E
Almeida, Marcia Furquim de
Ichihara, Maria Yury
Silva, Rita de Cássia Ribeiro
Teixeira, Maria Gloria
Barreto, Mauricio Lima
Blencowe, Hannah
Falcao, Ila Rocha
Ohuma, Eric O.
Rocha, Aline dos Santos
Alves, Flávia Jôse Oliveira
Costa, Maria da Conceição Nascimento
Idueta, Lorena Suárez
Ortelan, Naiá
Smeeth, Liam
Rodrigues, Laura C.
Lawn, Joy E
Almeida, Marcia Furquim de
Ichihara, Maria Yury
Silva, Rita de Cássia Ribeiro
Teixeira, Maria Gloria
Barreto, Mauricio Lima
Affilliation
"Múltipla ver em Notas"
Abstract
Background: Preterm birth ( < 37 weeks), low birth weight (LBW, < 2500g), and small for gestational age (SGA, < 10th centile of birth weight for gestational age and sex) are markers of newborn vulnerability with a high risk of mortality. We estimated the prevalence of phenotypes combining these three markers and quantified the mortality risk associated with them. Methods: Population-based cohort study using routine register-based linked data on all births and deaths in Brazil from January 1, 2011, to December 31, 2018. We estimated the prevalence of preterm, LBW, and SGA individually and for phenotypes combining these characteristics. The mortality risk associated with each phenotype: early neonatal, late neonatal, neonatal, post-neonatal, infant, 1-4 years, and under five years was quantified using mortality rates and hazard ratios (HRs) with 95% confidence interval (CI) were estimated using Cox proportional hazard models. Findings: 17,646,115 live births were included. Prevalence of preterm birth, LBW and SGA were 9.4%, 9.6% and 9.2%, respectively. Neonatal mortality risk was 16-fold (HR = 15.9; 95% CI:15.7–16.1) higher for preterm compared to term, 3 times higher (HR = 3.4; (95% CI:3.3–3.4) for SGA compared to adequate for gestational age (AGA), and > 25 times higher for LBW (HR = 25.8; (95% CI:25.5-26.1) compared to nor- mal birth weight (NBW). 18% of all live births were included in one of the small vulnerable newborn phenotypes. Of those 8.2% were term-SGA (4.7%NBW, 3.5%LBW), 0.6% were term-AGA-LBW, 8.3% preterm- AGA (3.8%NBW, 4.5%LBW) and 1.0% preterm-SGA-LBW. Compared to term-AGA-NBW, the highest mortal- ity risk was for preterm-LBW phenotypes (HR = 36.2(95%CI 35.6-36.8) preterm-AGA-LBW, HR = 62.0(95%CI 60.8-63.2) preterm-SGA-LBW). The increased mortality risk associated with vulnerable newborn pheno- types was highest in the first month of life, with attenuated but continued high risk in the post-neonatal period and 1-4 years of age.
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