557 - Neonatal mortality associated to bacterial sepsis in a middle-income country

Poster Number: 557
Publication Number: 557.428

Daniela T. Costa-Nobre, Universidade Federal de São Paulo - UNIFESP, São Paulo, Sao Paulo, Brazil; Carlos Roberto Kiffer, UNIFESP EPM, São Paulo, Sao Paulo, Brazil; Adriana Sanudo, Federal University of São Paulo, São Paulo, Sao Paulo, Brazil; Rita Balda, Universidade Federal de Sao Paulo, São Pailo, Sao Paulo, Brazil; MILTON H. MIYOSHI, unifesp, São Paulo, Sao Paulo, Brazil; Kelsy C. Areco, Federal University of São Paulo, São Paulo, Sao Paulo, Brazil; Mandira D. Kawakami, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil; Tulio Konstantyner, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Ana Silvia Marinonio, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Paulo Bandiera-Paiva, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Rosa V. Freitas, Fundação Seade, São Paulo, Brasil, Sao Paulo, Brazil; Lilian C. Morais, Fundação Seade, São Paulo, Sao Paulo, Brazil; Monica La Porte Teixeira, Fundação Seade, São Paulo, Sao Paulo, Brazil; Bernadette C. Waldvogel, UFMG, São Paulo, Sao Paulo, Brazil; Ruth Guinsburg, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Maria Fernanda B. Almeida, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Background: Each year 4 million neonatal deaths occur in the world. The WHO estimates that a quarter of them are caused by neonatal sepsis or pneumonia. In Brazil, neonatal sepsis was listed as the 4th cause of death in under-5 children, in 2015.

Objective: To analyze the characteristics of neonatal mortality due to bacterial sepsis and its associated factors between 2004-2015, in São Paulo (SP) State, Brazil.

Design/Methods: Population-based study with a database created by deterministic linkage of the Death and Birth Certificates including all live births ≥22 weeks gestational age (GA) without congenital anomalies, from 2004-2015, of mothers living in SP State. Neonatal deaths associated with bacterial sepsis (ICD10: A32.7, A40, A41.0-A41.5, P36 and P37.2) were compared to neonatal deaths without bacterial sepsis (none of the above mentioned ICD10 codes listed in any line of the Death Certificated). Demographic and maternal characteristics were compared, and Cox regression was used to investigate predictors of death among infants who died with bacterial sepsis, Kaplan-Meier curve was used to compare the impact of GA on the time of death among neonates that died with bacterial sepsis and those who died without bacterial sepsis.

Results: From 2004-2015, 7,165,209 live births were included. Among them, 7,123,494 survived the neonatal period, 15,088 died with bacterial sepsis and 26,627 died without bacterial sepsis. Compared to the deaths without sepsis, bacterial sepsis associated deaths occurred in infants with higher BW, GA, and Apgar scores (Table 1). Maternal age < 20years, less years of education, being single, prenatal care < 7 visits, multiple gestation, lower GA, male sex and lower 1st min Apgar scores increased the risk of bacterial sepsis associated deaths. Maternal age >=35 years, primiparous and cesarean delivery decreased the risk of bacterial sepsis associated deaths (Table 2). Kaplan Meier curve showed that deaths without sepsis occurred earlier in life than bacterial sepsis associated deaths (median 25 hours [95%CI 24-36] vs. 168 hours [168-171]). The contribution of GA is shown in Figure 1.Conclusion(s): Deaths without sepsis occurs earlier in the neonatal period while bacterial sepsis associated deaths were later, with half of them occurring after the first week of life. Besides the great impact of GA on the risk of death among infants who died with bacterial sepsis, demographic characteristics associated with social disadvantage and quality of prenatal care are also predictors of death.

FAPESP Grant: # 2017/03748-7; Agreement Fundação SEADE and EPM-Unifesp: #23089.004297/2008-11 e #23089.000057/2014-95
Table 1: Maternal and neonatal characteristics in the studied population according to the neonatal outcome, São Paulo State, Brazil, 2004-2015.
Table 2: Predictors of neonatal death among infants who died with bacterial sepsis compared to survivors, cox regression adjusted by year, São Paulo State, Brazil, 2004-2015.