Parto acidental não-hospitalar como indicador de risco para a mortalidade infantile

Abstract

Objectives: to examine diferences in infant mortality rates by place of birth, in the State of São Paulo (2009). Methods: a cohort of all 252,201 live vaginal births, with 3,289 infant deaths, was obtained from a deterministic linkage and divided into those born in hospital (250,850) and those born at home or else- where (1351). The probability of death and relative risk (RR) were calculated and a multinomial logistic regression model was used to assess the effect of co- variables on mortality. Results: 0.5% live births occurred in the home or elsewhere outside the hospital and presented a greater likelihood of mortality (45.2 per thousand live births) compared with those born in hospital (12.9). Mortality was higher for births outside of hospital for all types of infant mortality: early neonatal (RR=3.9), late neonatal (RR=2.6) and post-neonatal (RR=3.4). The likelihood of death diminished as birth weight increased, although the risk of death for live births ≥2500 g in the home or elsewhere was twice as high as for hospital births. After adjustment, being born outside of hospital continued to be a risk factor for post-neonatal mortality. Conclusions: although few in number, births outside of hospital present a greater risk of death, including post-neonatal mortality, suggesting that there are barriers to access not only during the prenatal period and delivery, but also throughout the first year of life.