Neonatal near miss and the occurrence of negative outcomes in the first year of life: data from a national survey, Nascer no Brasil (Born in Brazil), 2011-2012

Abstract Objectives: estimate the strength of association between neonatal near miss and the nega-tive outcomes in the child’s first year of life. Methods: a prospective cohort study on neonatal survivors originating from a national survey “Nascer no Brasil (Born in Brazil), 2011-2012.” Main exposure: neonatal near miss (NNM). Negative outcomes: breastfeeding, hospitalization, and post neonatal death (tele-phone interview). For each outcome, the odds ratio (OR) were estimated by univariate (p<0.2) and multivariate (p<0.05) logistic regression models. Results: among 15,675 children 3.3% were neonatal near miss. Neonatal near miss was associated, after adjusting, to: weaning (OR=1.8); hospitalization after hospital discharge (OR=2.2); remained hospitalized (OR=65.6) and post neonatal death (OR=52.4) The increased OR after adjusting revealed negative confounding, such as “remained hospitalized since childbirth” (ORcrude=21.1 and ORadjusted=65.6). Conclusions: although neonatal near miss reflects a good quality of health care, avoiding neonatal death, these survivors have higher risk of negative outcomes in the first year of life.

摘要：
研究目的：评估新生儿近危重症（neonatal near miss, NNM）与儿童出生后第一年不良结局之间的关联强度。
研究方法：针对2011-2012年全国调查《Nascer no Brasil（巴西出生）》中的新生儿存活者开展前瞻性队列研究。主要暴露因素为新生儿近危重症（NNM），不良结局包括母乳喂养结局、住院情况及新生儿后期死亡（通过电话访谈获取）。针对每一种结局，采用单因素（p<0.2）及多因素（p<0.05）logistic回归模型估算比值比（odds ratio, OR）。
研究结果：本研究共纳入15675名儿童，其中3.3%为新生儿近危重症病例。校正后分析显示，新生儿近危重症与以下结局显著相关：断奶（OR=1.8）、出院后住院（OR=2.2）、持续住院（OR=65.6）及新生儿后期死亡（OR=52.4）。校正后比值比升高提示存在负混杂偏倚，例如“自分娩起持续住院”这一因素（粗OR=21.1，校正OR=65.6）。
研究结论：尽管新生儿近危重症提示医疗保健质量良好，成功避免了新生儿死亡，但此类存活儿童在出生后第一年发生不良结局的风险更高。