Determinants of neonatal survival among newborns who died between 2014 and 2017 in Ecuador A study analyzing national databases

Abstract

Introduction: Neonatal mortality is an indicator in public health. In Ecuador, the neonatal death rate is 6 per 1,000 live births. The objective of this study was to identify the main determinants of neonatal mortality in newborns who died between 2014 and 2017 in Ecuador.

Methodology: This study is an analysis of the national database of the National Institute of Statistics and Censuses of Ecuador-INEC and the Ministry of Public Health of Ecuador, which records the mortality of newborns who died between 2014 and 2017. Prenatal variables were evaluated, natal, postnatal and sociodemographic conditions and their association with mortality, measured in days of survival. Adjusted hazard ratios for neonatal death (Hazard Ratio [HR]) were estimated using Cox proportional hazards models and inverse probability-weighted Cox regression.

Results:A total of 2893 newborns were included in the study, 1380 (48%) were female; median gestational age (P25 to P75) at birth: 31 (27 to 36) weeks. The median survival time in days of life was significantly longer for each increase in Apgar score at 5 minutes: 0.2 days for ≤ 4 points, 2 days for 5 points 2.9 days for 6 points, 3.1 days for 7 points, 3.8 days for 8 points, 4.4 days for 9 points, and 5.5 days for 10 points. After adjusting for prenatal, natal, postnatal, and sociodemographic variables, the HR was 32% (95% CI: 27% to 37%) higher for each two- to three-point decrease in Apgar (P < 0.01).

Conclusions: The APGAR assessment at 5 minutes predicts the survival of the newborns, the higher values are associated with more survival. The factors that increase the risk of mortality are adolescent and elderly maternal age, extreme premature gestational age, extreme low weight, the presence of malformations and neonatal asphyxia. The sociodemographic factors were births in first level institutions and newborns born in zone 3 of Ecuador (Cotopaxi, Tungurahua, Chimborazo and Pastaza).