Epidemiological Profile of Precocious Neonatal Mortality in the Period 2008 to 2015 in Porto Velho, Rondonia, Brazil

The objective of this study was to describe the epidemiological profile of precocious neonatal infant mortality in the city of Porto Velho, Rondonia. A quantitative, descriptive study with an ecological approach was carried out. The data source used was secondary, originating from the linkage between SINASC and SIM databases, from the Health Surveillance Agency of the Rondonia Health Department. For treatment, absolute frequency analyzes were performed. The neonatal infant mortality rate was 9.7 deaths per thousand live births, with a predominance of the preterm neonatal patient: 7.2 deaths per thousand live births. Of the deaths, 482 (72.8%) occurred in the precocious neonatal period (0 to 6 days) and 164 (24.7%) in the late neonatal 7 to 27 days of life. The findings indicate the need to improve the quality of health care services available in the city, both prenatal and obstetric care in the neonatal period.


INTRODUCTION
The infant mortality rate (death of children under one year per thousand live births -NVs) is a sensitive indicator of social, economic development and above all health care in a given geographic space and time. Infant mortality is still divided into neonatal mortality (death 0-27 days) and post-neonatal mortality (27 days for deaths until 364 days of age). Since neonatal mortality and also divided into two periods, precocious neonatal (0 to 6 days) and late neonatal (7 to 27 days). Although the global rate of infant mortality (under five years) has reduced by 49% between 1990 and 2013 -from 90 to 46 deaths per thousand NVs -74% of these deaths corresponded to children under one year and 44% occurred in the neonatal period (zero to 27 days of life). Data from a survey conducted by Moreira, et al (2014) in the city of Porto Velho, showed a predominance of deaths in children under years born to mothers aged 20 to 34, whose percentage ranged from 26.0% in 2006 29.0% in 2010, with percentage swings in other years. Over this period, the study showed an increasing trend from premature deaths. Between 2006 and 2007 this percentage was maintained in 50.0%, increasing to 53% in 2008 and in 2010, representing 54.0% of deaths in children under 1 year, featuring intense incidence of neonatal mortality in preterm (MOREIRA et al, 2014). In 2013, the leading causes of neonatal death in the world were complications from premature birth (35%) and labor (24%) and attributed to sepsis (15%), considered one of the leading causes of death in this age group in Brazil. This situation and due to the more pronounced reduction in deaths in the post-neonatal period, which reflects social inequalities, coverage and quality of health care. Already neonatal deaths have close relationship with the health care provided to pregnant women and newborns during the antepartum, delivery and immediate care to child at birth. Another relevant situation and the high proportion of neonatal deaths in the first day and the first week of life, which shows the relationship of neonatal mortality with the health care provided to pregnant women and newborn and the need to consider the targeted actions the improvement of such assistance (LORENZO, Brunken and LUPPI, 2013). One of the biggest current challenges to reduce infant mortality in our country and the proper care of the newborn, in addition to monitoring the entire cycle pregnancy until the birth of the baby, with quality service at all levels of complexity.
The timely and effective access to obstetric and neonatal care quality, from the prenatal care, delivery care, postpartum and care received by the newborn also contribute to reducing the incidence of diseases and, consequently, a higher survival rate of newborn -born, especially newborns risk. Thus, the aim of this study was to identify and characterize the epidemiology of neonatal infant mortality in Porto Velho, from 2008 to 2015.

II.
METHODS It is a quantitative study of descriptive character with ecological approach. Data collection was performed using a previously tested instrument adapted Oliveira (2009), which extracted the secondary data information infant deaths neonatal period defined stratified from the following sources of information: Information System born Alive -SINASC; Mortality Information System -SIM, coming from the State Agency of Health Surveillance of Rondônia-RO-AGEVISA. Deaths were described according to the main groups for deaths from causes listed on the death certificate obtained by linkage of the research bank with the SIM and the causes registered in the records. This list of causes groups the codes of 10 the revision of the International Classification of Diseases (ICD-10). Data were analyzed using absolute and relative frequency of the selected variables. For the last step, it was carried out GIS data of deaths in the neonatal period, distributed in the city, from 2008 to 2015. The data were spatially on a vector basis of the urban area of the Old Port district headquarters, purchased from the Secretary of Old Port of City planning -SEMPLAN (2017), so that each neighborhood presents a value corresponding to the processed data. It was used as a tool of expertise and building maps: Geographic Information System -GIS, through Software Quanto Giz -Qgiz, version 2.8.1. The causes of higher prevalence of neonatal deaths in this study with a percentage equal to 25% are related to bacterial septicemia RN, being considered deaths from preventable causes. Bacterial sepsis is considered a disease originated in the perinatal period and should be understood as a preventable cause. Originates in precocious pregnancies, this cause is defined as a clinical syndrome characterized by nonspecific and systemic inflammatory response correlated to the presence of bacteria in sterile body fluids. Precocious sepsis is related to pregnancy and / or peripartum factors, and the etiological agents originating from the maternal genital tract or maternal bacteremia. Streptococcus agalactiae , Escherichia coli and Listeria monocytogenes are the main bacteria responsible for precocious onset of disease. Among the most common clinical signs in sepsis stand-disordered breathing (Aquino et al, 2009). This feature explains the finding of n = 105 neonatal deaths that were diagnosed with respiratory distress, associated with septicemia. On this, Malta et al (2010) reports that in developing countries, infant mortality is high and a significant portion of this number is due to perinatal and neonatal mortality. The main causes of perinatal mortality are associated with prematurity, to bacterial septicemia, asphyxia, the intrauterine infections, toxemia of pregnancy and multiple birth defects as those referred to the neonatal period are the intrauterine acute infections, respiratory problems, birth defects, the prematurity and postnatal infection, is taking an amount that varies depending on operating conditions of the Maternity and Nursery. In recent decades, the mother's obituary declined to almost vanish; By that time, perinatal losses did not follow the same rhythm when considering the balance between the scientific and technological progress and the possibility that these resources are available to the pregnant woman, the fetus and the newborn, in countries not in the first world (BRAZIL, 2015). In maternity wards of the least favored regions, such as the northern region, the nurseries have little equipment resources, limited physical area, large numbers of newborns at risk and especially small number of personnel (nurses, aides, etc. .), often not well trained. A preventable death is one whose occurrence is related to medical intervention and quality health services. The preventability now considered according to various criteria to organize and cover the different factors that contribute to the occurrence of these deaths, in addition to analyzing the effectiveness of the health system (Pereira et al., 2016) It is considered that the birth weight is alone, the major risk factor related to neonatal mortality (Faria et al, 2014). With regard to the second deaths birthweight, which was evidenced during the study period, there were n = 169 (25.5%) neonatal deaths in infants who weighed less than 1 kg, followed n = 108 (16.3%) with less than 1.4 kg (Figure 1). Gizaw et al, (2014) reported that low birth weight is an important indirect cause of death, but maternal complications at work are at high risk of neonatal death, and poverty is also strongly associated with an increased risk. The highest proportion of low birth weight neonates, ie, birth weight less than 2.5kg, found in the studied population, shows that low birth weight is a risk factor for neonatal mortality, and that as the weight birth increases the risk of death decreases significantly.

III. RESULTS
Corroborating these findings cite the study by Potrich et al. (2011) with data from the city of Santa Maria -Rio Grande do Sul, in the database of the Department of the Unified Health System (DATASUS) with RNs to identify mortality, where it was found that from 2000 to 2008 there was a higher frequency of deaths weighing less than 1.5 kg. Another study conducted in the state of Pernambuco through information contained in the SIM database showed that a total of 8,055 deaths from 2009 to 2011, 63.1% (n = 5,083), ie, most were neonates weighing less than 2.5 kg (Pereira et al, 2016). In relation to birth weight, 60% of infant deaths are infants with low birth weight. On the other hand, that the longer the lifetime, the greater the proportion of weight not informed on the death certificate.

International Journal of Advanced Engineering Research and Science (IJAERS)
[    /dx.doi.org/10.22161/ijaers.5.6.17  ISSN: 2349-6495(P) | 2456-1908(O) In this study, the n = 482 neonatal deaths occurred in the period, n = 191 (47.6%) were mothers residing in area neighborhoods east of the city of Porto Velho (Figure 3).  This aspect points to the need to enter the local territories and identify the details that lead to vulnerabilities that can result in death in children less than year or even variations in the same territory.

International Journal of Advanced Engineering Research and Science (IJAERS)
[Vol-5, Issue-6, Jun-2018] https: //dx.doi.org/10.22161/ijaers.5.6.17  ISSN: 2349-6495(P) | 2456-1908(O) From this, Figure 4 shows the geographical distribution in the city of Porto Velho of preventable neonatal deaths. 50.9% (220) of the total cases of deaths in the precocious neonatal period, were by preventable diseases that comprises the group. In developing countries, more than nine million children die every year before birth and the first week of life as a result of complications during pregnancy. Many of these deaths are preventable. Overall, seven million women are affected by health problems related to pregnancy (YEGO et al., 2013).
In the northern region the impact is even greater by the lack primary health care service coverage and poor quality of the existing ones. According to the Quality Improvement Program of Primary Care (BRAZIL, 2017), the infrastructure of existing services and work processes are responsible for the low quality of care in this area, the discrediting of the front population to primary care model and the great looking to the medium and high complexity services.
Although not an objective of this study, the association made between the deaths in the precocious neonatal period and primary health care coverage area, showed that of the 59 neighborhoods with death records, only 18 (30.5%) are neighborhoods with coverage family health.
Souza and Melo (2013) state that one of the health care indicators that are linked to infant death is the coverage of the Family Health Strategy. This indicator is using as a variable in analyzes on the effects of AB on health conditions in the municipalities. In this respect it is possible to identify whether there was improvement in health indicators in relation to the degree of coverage. The population coverage of family health teams was also used in other evaluations of the effectiveness of primary care in Brazil (Serra, 2004;PEIXOTO and ROCHA, 2008). The findings lead us to reflect on the importance of family health coverage strategy and the impact that this cause in infant mortality. Taking into account that the practices developed by the SF teams are mostly focused on maternal and child health, it is clear that these indicators could be lower if there were more family health teams in the territories of the city's neighborhoods.
Neonatal mortality was high in this study, with an average of 83 deaths per 1,000 live births. In this group, the findings even more impressive when one realizes that in the precocious neonatal component (death less than 07 days), showed an increase of the coefficient of 6.4 in 2008 to 9.2 in 2015. SIM for both neonatal deaths as precocious neonatal, and no major discrepancies between the dead and live births in the context of death in the perinatal period. No entanto, a proporção de ausência de informação em campos referentes à escolaridade materna e antecedentes obstétricos, por exemplo, bem como a discordância e variabilidade para o campo duração da gestação, evidenciam a necessidade de sensibilização e capacitação continuada de toda equipe envolvida no fluxo da DO, desde seu preenchimento nas unidades assistências de saúde até a entrada dos dados no sistema de informação da secretaria de saúde, bem como dos gestores. Another point to be discussed is the need for constant strengthening of infant mortality prevention committee and fetal development, especially regarding the death investigation, given the opportunity to enter or change information in the revised system. Despite the completeness of almost 96% found in the "underlying cause of death" between the perinatal deaths, the reliability evaluation or validation of the information contained in this field is not included in this thesis, therefore, additional studies to examine this information can help SIM qualification as a reliable tool for assessing perinatal deaths.
Since the precocious neonatal deaths occur in the 1st week of life, it is suggested the need to restructure the Stork municipal network, with investment in care for pregnant women and newborns. In addition, the network coverage expansion of maternal and child care, redefinition of geographical and population criteria to facilitate the access of pregnant women, mothers and newborns to this loca network will contribute to the improvement of indicators.