406 - Association of resuscitation training and neonatal mortality with perinatal asphyxia: a temporal and spatial analysis

Publication Number: 406.3895

Mandira Daripa Kawakami, Federal University of Sao Paulo, Atibaia, Sao Paulo, Brazil; Ana Silvia Marinonio, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil; Adriana Sanudo, UNIFESP, Brazil, Sao Paulo, Brazil; Daniela T. Costa-Nobre, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Kelsy C N. Areco, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil; Rita de Cássia X. Balda, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil; Tulio Konstantyner, Universidade Federal de Sao Paulo, São Paulo, Sao Paulo, Brazil; Milton Miyoshi, Universidade federal de sao paulo, Sao Paulo, Sao Paulo, Brazil; Paulo Bandiera-Paiva, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Carina Oliveira, UNIVERSIDADE FEDERAL DE SAO PAULO, Sao Paulo, Sao Paulo, Brazil; Rosa Freitas, Uslp, São Paulo, Sao Paulo, Brazil; Monica La Porte. Teixeira, Fundacao Seade, São Paulo, Sao Paulo, Brazil; Bernadette Cunha. Waldvogel, Fundação Sistema Estadual de Análise de Dados-SEADE, São Paulo, Sao Paulo, Brazil; Carlos Roberto Kiffer, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil; Ruth Guinsburg, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil; Maria Fernanda de Almeida, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil

Background: The Brazilian Neonatal Resuscitation Program (NRP) has trained over 150,000 health care professionals (HCP) in the last 30 years. The impact of this training on neonatal deaths associated with perinatal asphyxia is unknown.

Objective: To evaluate the association of neonatal mortality rate with perinatal asphyxia (asphyxia-NMR) with the presence of NRP trained HCP in São Paulo State (SP), Brazil, from 2011 to 2020.

Design/Methods: Population based study of live births (LB) and deaths from 0-27 days without congenital anomalies and birthweight ≥1500g in ten years in SP, where 20% of the country’s LB occur. The database was built by LB and death certificates linkage according to municipality of birth. Asphyxia was defined by WHO-ICD10 if intrauterine hypoxia (P20), birth asphyxia (P21) or neonatal aspiration of meconium (P24.0) was present in any line of the death certificate. The number of HCP (physicians and nurses) trained by Brazilian NRP, according to their municipality of residence, was provided by Brazilian Pediatric Society. The trained HCP rate was the cumulative number of HCP trained/1000 LB for each study year, considering an annual work force loss of 10% in 2010-2015 and 20% in 2016-2020. Prais-Winsten was used to analyze the temporal trends of asphyxia-NMR and trained HCP rate, expressed by annual percentage change. Pearson linear correlation measured the association between asphyxia-NMR, trained HCP rate and public health expenditure per capita. Spatial distribution of asphyxia-NMR and trained HCP rate by the 645 municipalities of SP was studied with TerraView software (INPE, Brazil).

Results: Over the 10 years, 6,044,527 LB occurred in SP, and 2527 neonates ≥1500g without anomalies died with perinatal asphyxia. Table shows the crude numbers of all studied variables. Asphyxia-NMR decreased 3.84%/year (95%CI: -7.10 to -0.46) and trained HCP rate increased 39.97%/year (95%CI: 24.50 to 57.35%) during the study period (Figure 1). There was an inverse correlation between asphyxia-NMR and trained HCP rate (r: -0.860; -0.966 to -0.503; R2=0.74) and between asphyxia-NMR and public health expenditure per capita (r: -0.820; -0.956 to -0.395). Asphyxia-NMR ≥1.0 decreased from 61 municipalities in 2011-2015 to 28 in 2016-2020, while trained HCP rate ≥5 increased from 66 to 131 municipalities in the state (Figure 2).

Conclusion(s): The results suggest that Brazilian NRP training, associated with government health investment, helped to improve neonatal care at birth.
(Funding FAPESP 2017/03748-7; Agreement Fundacao SEADE-Unifesp 23089.120254/2019-34)

Table: Neonatal mortality rate with perinatal asphyxia (asphyxia-NMR), Brazilian Neonatal Resuscitation Program (NRP) trained health care professionals rate (trained HCP rate) and public health expenditure per capita in Brazilian Reais (R$), according to year of birth.


Figure 1: Pearson linear correlation between neonatal mortality rate with perinatal asphyxia (asphyxia-NMR) and Brazilian Neonatal Resuscitation Program trained health care professionals rate (trained HCP rate); São Paulo State, Brazil, 2011-2020


Figure 2: Municipalities’ spatial distribution in 2011-2015 and 2016-2020 according to: (A-blue) neonatal mortality rate with asphyxia in neonates ≥1500g without congenital anomalies; and (B-red) Brazilian Neonatal Resuscitation Program trained health care professionals rate, São Paulo State, Brazil