Fatores associados às anormalidades congênitas que evoluíram ao óbito infantil
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Data
2022-11-30
Autores
Ribeiro, Ana Carolina de Castro
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Universidade Estadual Paulista (Unesp)
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Introdução: A mortalidade infantil (MI) constitui importante marcador de desenvolvimento de um país, pois demonstra o nível de saúde da população e revela a efetividade das políticas públicas de promoção à saúde, bem como a capacidade da assistência à gestante, ao parto, e à criança em seus primeiros anos de vida. Segundo dados do Instituto Brasileiro de Geografia e Estatística (IBGE), no ano de 2015, a taxa de MI foi de 13,8 por mil nascidos vivos (NV) no Brasil, enquanto a taxa mundial em 2019 foi 38 por mil NV. As principais causas de morte de menores de 5 anos no Brasil, em 2015, foram a prematuridade (3,2 por 1000 NV) e as anormalidades congênitas (3,1 por 1000 NV), definidas como anormalidades estruturais ou funcionais que ocorrem durante a vida intrauterina. As anormalidades congênitas mais prevalentes em São Paulo são as do sistema osteoarticular, cardiovascular, de cabeça e pescoço, e do sistema genital. O tema mostra sua relevância ao constituir a segunda causa de mortes na infância e tal fato, aliado a ausência de estudos recentes que abordem as anormalidades congênitas como fator associado ao óbito infantil, justificam a realização do presente estudo. Objetivo: identificar os fatores associados às anormalidades congênitas que evoluíram ao óbito infantil. Método: Trata-se estudo descritivo e de base populacional. Utilizaram-se dados secundários do Sistema de Informações de Mortalidade (SIM), incluindo os óbitos infantis ocorridos no Brasil entre 2011 e 2020. Analisaram-se variáveis sociodemográficas maternas, sobre as características do óbito e do feto. Resultados: De maneira independente, aumentaram o risco de óbito por anormalidade congênita: idade materna entre 35 e 40 anos e acima de 40 anos; residir nas regiões Norte, Nordeste, Centro-oeste ou Sudeste, comparado à região Sul; nascer por operação cesariana e ter baixo ou muito baixo peso ao nascer. Também de maneira independente, foram fatores de proteção para óbito por anormalidade congênita: ser adolescente, com cor da pele/raça parda ou preta, com baixa escolaridade, sem trabalho remunerado e com cinco ou mais filhos vivos. Também protegeram do óbito por anormalidade congênita, o nascimento por gestação múltipla, a prematuridade ou pós termo, o óbito após a primeira semana de vida e a ocorrência fora do ambiente hospitalar. Por fim, o resultado relativo ao sexo masculino pode decorrer do acaso. A maior taxa de mortalidade por anormalidade congênita foi associada ao sistema nervoso (38%). Conclusões: A idade materna constitui importante fator de risco modificável relativo à anormalidade congênita; o tipo de parto e o peso ao nascer podem ser consequentes a tais anormalidades; variáveis que, no conjunto, indicam vulnerabilidade socioeconômica, constituíram fator de proteção.
Introduction: Infant mortality (MI) is an important marker of a country's development, as it demonstrates the level of health of the population and reveals the effectiveness of public policies to promote health, as well as the capacity of care for pregnant women, childbirth and the child in his early years of life. According to data from the Brazilian Institute of Geography and Statistics (IBGE) in 2015, the MI rate was 13.8 per thousand live births (LB) in Brazil, while the worldwide rate in 2019 was 38 per thousand LB. The main causes of death of children under 5 years of age in Brazil in 2015 were prematurity (3.2 per 1000 LB) and congenital abnormalities (3.1 per 1000 LB), structural or functional abnormalities that occur during intrauterine life. The most prevalent congenital abnormalities in São Paulo are those of the osteoarticular, cardiovascular, head and neck system, and the genital system. The theme shows its relevance in constituting the second cause of childhood deaths and this fact, together with the absence of recent studies addressing congenital abnormalities factors as a factor associated with infant death, justify the performance of the present study. Objective: to identify the factors associated with congenital abnormalities that evolved to infant death. Method: This is a descriptive and population-based study. Secondary data from the Mortality Information System (SIM) were used, including infant deaths that occurred in Brazil between 2011 and 2020. Maternal sociodemographic variables were analyzed on the characteristics of death and fetus. Results: Independently, the risk of death due to congenital abnormality increased: maternal age between 35 and 40 years and over 40 years; reside in the North, Northeast, Midwest or Southeast regions, compared to the South; born by caesarean section and have low or very low birth weight. Also independently, they were protective factors for death due to congenital abnormality: being adolescent, with skin color/brown or black race, with low schooling, without paid work and with five or more living children. They also protected against death due to congenital abnormality, birth due to multiple gestation, prematurity or post-term birth, death after the first week of life and occurrence outside the hospital environment. Finally, the result for males may be due to chance. The highest mortality rate due to congenital abnormality was associated with the nervous system (38%) Conclusions: Maternal age is an important modifiable risk factor for congenital abnormality; the type of delivery and birth weight may be consequential to such abnormalities; variables that, as a whole, indicate socioeconomic vulnerability, constituted a protective factor.
Introduction: Infant mortality (MI) is an important marker of a country's development, as it demonstrates the level of health of the population and reveals the effectiveness of public policies to promote health, as well as the capacity of care for pregnant women, childbirth and the child in his early years of life. According to data from the Brazilian Institute of Geography and Statistics (IBGE) in 2015, the MI rate was 13.8 per thousand live births (LB) in Brazil, while the worldwide rate in 2019 was 38 per thousand LB. The main causes of death of children under 5 years of age in Brazil in 2015 were prematurity (3.2 per 1000 LB) and congenital abnormalities (3.1 per 1000 LB), structural or functional abnormalities that occur during intrauterine life. The most prevalent congenital abnormalities in São Paulo are those of the osteoarticular, cardiovascular, head and neck system, and the genital system. The theme shows its relevance in constituting the second cause of childhood deaths and this fact, together with the absence of recent studies addressing congenital abnormalities factors as a factor associated with infant death, justify the performance of the present study. Objective: to identify the factors associated with congenital abnormalities that evolved to infant death. Method: This is a descriptive and population-based study. Secondary data from the Mortality Information System (SIM) were used, including infant deaths that occurred in Brazil between 2011 and 2020. Maternal sociodemographic variables were analyzed on the characteristics of death and fetus. Results: Independently, the risk of death due to congenital abnormality increased: maternal age between 35 and 40 years and over 40 years; reside in the North, Northeast, Midwest or Southeast regions, compared to the South; born by caesarean section and have low or very low birth weight. Also independently, they were protective factors for death due to congenital abnormality: being adolescent, with skin color/brown or black race, with low schooling, without paid work and with five or more living children. They also protected against death due to congenital abnormality, birth due to multiple gestation, prematurity or post-term birth, death after the first week of life and occurrence outside the hospital environment. Finally, the result for males may be due to chance. The highest mortality rate due to congenital abnormality was associated with the nervous system (38%) Conclusions: Maternal age is an important modifiable risk factor for congenital abnormality; the type of delivery and birth weight may be consequential to such abnormalities; variables that, as a whole, indicate socioeconomic vulnerability, constituted a protective factor.
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Anormalidades congênitas, Mortalidade Infantil, Fatores associados, Saúde pública