# Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit

## TL;DR

This study identifies preventable factors contributing to neonatal and postneonatal deaths in Brazil's Northeast, showing that better access to healthcare can reduce mortality.

## Contribution

The study identifies specific preventable factors associated with neonatal and postneonatal mortality in a Brazilian cohort, emphasizing the role of healthcare access.

## Key findings

- Neonatal and postneonatal mortality were significantly associated with abortion history, perinatal asphyxia, early neonatal sepsis, and umbilical venous catheterization.
- The neonatal mortality rate was 3.47 deaths per thousand live births, lower than the national average.
- Improved access to health services through private plans was linked to better outcomes for pregnant women and newborns.

## Abstract

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10−8.03‰), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services.