Tendência da mortalidade neonatal no nordeste brasileiro de 2014-2023

Abstract

INTRODUCTION: Neonatal mortality corresponds to death between zero and 27 days of life, constituting a significant public health problem, especially in developing countries. In Brazil, the highest rates are concentrated in the North and Northeast regions, highlighting marked inequalities compared to the South and Southeast. OBJECTIVES: To analyze the trend of neonatal mortality and its elements, as well as its distribution in the Brazilian Northeast region from 2014-2023. METHODOLOGY: This ecological time-series study analyzed the behavior and trends of neonatal deaths in Northeast Brazil from 2014 to 2023, using secondary data obtained from the Mortality Information System. The data were categorized and organized for descriptive and regression statistical analysis using Rstudio® software with a Prais-Winsten regression model. Causes were analyzed according to the groups in Chapter 10 of the International Classification of Diseases. RESULTS: A total of 62,600 neonatal deaths were recorded, of which 76.8% occurred in the early period and 23.2% in the late period, peaking in 2017 and 2018 with the highest concentration in Bahia and Pernambuco. Deaths were mainly concentrated among male newborns (55.3%), mixed-race infants (70.7%), and those with extremely low birth weight (34.1%), predominantly among children of young mothers (20-29 years old), mixed-race infants (70.7%), and those with intermediate education levels (47.9%). Deaths due to perinatal conditions and congenital malformations were prominent. Early neonatal deaths were the majority, with rates remaining unchanged throughout the decade, while late neonatal deaths increased after 2020, and total rates remained similar throughout the period, even slightly increasing. Bahia and Sergipe showed the highest rates, while Ceará and Alagoas recorded the lowest. In the later period, Sergipe and Piauí led the indicators, contrasting with Rio Grande do Norte and Alagoas, which showed the lowest marks. The overall trend in total neonatal mortality for the Northeast region is one of stability (p=0.633). Among the states, Paraíba showed an increasing trend (APC=1.49%; p=0.021), Rio Grande do Norte a decreasing trend (APC=-1.18%; p=0.008), and the remaining states remained stable. For the early neonatal period, there was a decline in Rio Grande do Norte (APC=-1.85%; p=0.015) and Piauí (APC=- 1.21%; p=0.045) and an increase in Sergipe (APC=1.54%; p=0.020). In the regional panorama, the rates stabilized (p=0.187). For the late neonatal period, there is systemic progression in the region (APC=1.70%; p=0.001); among the states, progression is observed in Bahia (APC=3.24%; p=0.002). Peak growth was observed in Paraíba (APC=3.17%; p=0.010) and Alagoas (APC=1.42%; p=0.049), while mortality remained stable in the other states. CONCLUSION: Neonatal mortality remained stable in the Northeast, with variations between states: a reduction in Rio Grande do Norte and Piauí, and an increase in Paraíba and Sergipe. A notable increase occurred in the late neonatal period in Alagoas, Bahia, and Paraíba, and regionally as a whole. Early deaths due to preventable perinatal causes predominated, indicating persistent challenges and shortcomings in care, requiring improved care.