Extreme prematurity in a public reference unit: morbidity, viability and mortality





Premature; Morbidity; Mortality; Fetal viability.


Premature birth is a public health problem due to the high mortality rate associated and risk of severe disabilities throughout life. The objective was to evaluate the morbidity and mortality in a high-risk maternity hospital and knowing the threshold of viability. The sample was selected in four stages: identification, selection, stratification of preterm infants by gestational age and birth weight, and structured data collection. Neonates up to 31 weeks of gestational age who had a death outcome were evaluated from August 2015 to August 2020 through a retrospective survey based on the descriptive analysis of variables related to pregnancy, childbirth, and the newborn. Absolute and relative percentages were described for the categorical variables and calculated mean, median and standard deviation, minimum and maximum value for continuous quantitative variables. Most newborns had a small gestational age (56.3%), extremely low birth weight (39.8%), and presented with asphyxia (38.7%). The main morbidities were respiratory distress syndrome (100%) and sepsis (40.6%). The overall mortality rate was 55.9% from 26% at 31 weeks to 100% at 22 weeks; most deaths (56.3%) occurred between 22 and 27 weeks. Of the 266 deaths, 25 (9.3%) still occurred in the delivery room and 237 (89%) in the neonatal unit. The early mortality rate was 0.77 deaths per 1,000 live births, and the late mortality rate was 0.22 deaths per 1,000 live births. Viability’s limit found was 28 weeks. Death, in addition to fetal characteristics, was influenced by a series of modifiable risk factors.


Aynalem, Y. A. et al. (2021). The magnitude of neonatal mortality and its predictors in ethiopia: a systematic review and meta-analysis. International Journal of Pediatrics (United Kingdom), v. 2021, n. February.

Al-Mouqdad, M. M. et al. (2018). The consequences of prolonged duration of antibiotics in premature infants with suspected sepsis in a large tertiary referral hospital: a retrospective cohort study. International Journal of Pediatrics and Adolescent Medicine, v. 5, n. 3, p. 110–115.

Ambrósio, C. R.; Almeida, M. F. B.; Guinsburg, R. (2016). Opinions of brazilian resuscitation instructors regarding resuscitation in the delivery room of extremely preterm newborns. Jornal de Pediatria, v. 92, n. 6, p. 609–615.

Ambrósio, C. R.; Silva, C. H. M. da; Melo, É. G. A. (2016). Aspectos éticos do nascimento no limite de viabilidade tt - ethical aspects of birth in the limit of viability. Rev. Méd. Minas gerais, v. 26, p. [1-5].

Apgar, V. (2015). A proposal for a new method of evaluation of the newborn infant. Anesthesia and analgesia, v. 120, n. 5, p. 1056–1059.

Areia, A. L. et al. (2018). Corticotherapy for fetal lung maturation. Acta Obstet Ginecol port, v. 12, n. 4, p. 311–313.

Alleman Bw, Bell Ef, Li l, Dagle Jm, Smith Pb, Ambalavanan N, et al. (2013). Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics.

Aziz, K. et al. (2020). Part 5: Neonatal Resuscitation 2020. American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics, v. 112, n. 24 suppl, p. 30.

Barfield, W. D. (2018). Public health implications of very preterm birth. Clinics in Perinatology, v. 45, n. 3, p. 565–577.

Barros, F. C. et al. (2018). Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration. Bmj open, v. 8, n. 8, p. 1–9.

Bartman, T. et al. (2015) Apgar score at 5 minutes is associated with mortality in extremely preterm infants even after transfer to an all referral NICU. American Journal of Perinatology, v. 32, n. 13, p. 1268–1272.

Bittar, R. E. (2018) Parto pré-termo. Rev Med (São Paulo), v. 97, n. 2, p. 195–207.

Bouzada, M. C. F. et al. (2018) Response to newborn resuscitation procedures in the fifth minute of life in newborns Apgar ≤ 3 in the first minute. Revista Médica de Minas Gerais, v. 28, p. 31–37.

Brasil (2021). Ministério da Saúde. Datasus, 2014. Disponível em: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinasc/cnv/nvuf.def. Acesso em: 20 nov.

Brasil. (2021). Ministério da saúde. Datasus, 2020 [home page da internet]. O número de nascimentos prematuros no estado de alagoas 2015 a 2018. Disponível em: https://datasus.saude.gov.br/ acesso em: 17 nov. 2021.

Carvalho, W. B.; Matsushita, F. Y.; Krebs, V. L. J., (2019). Gray zone: mortality profile of newborns at the limit of viability. Revista da Associação Medica Brasileira, v. 65, n. 9, p. 1128–1129.

Castro, E. C. M. de; Leite, Á. J. M.; Guinsburg, R. (2016). Mortalidade com 24 horas de vida de recém‐nascidos pré‐termo de muito baixo peso da região nordeste do Brasil. Revista paulista de pediatria, v. 34, n. 1, p. 106–113.

Chawanpaiboon, S. et al. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The lancet global health, v. 7, n. 1, p. E37–e46.

Chee, Y. et al. (2017). Neonatal outcomes of preterm or very-low-birth-weight infants over a decade from queen mary hospital, hong kong: comparison with the vermont oxford network. Hong kong medical journal, v. 23, n. 4, p. 381–386.

Chun, J. et al. (2017). Prophylactic versus early rescue surfactant treatment in preterm infants born at less than 30 weeks gestation or with birth weight less than or equal 1,250 grams. Journal of korean medical science, v. 32, n. 8, p. 1288–1294.

Cnattingius, S.; Johansson, S.; Razaz, N. (2017). Apgar score and risk of neonatal death among preterm infants. New England Journal of M edicine, v. 383, n. 1, p. 49–57.

Cristina, N. et al. (2021). Fatores associados à mortalidade neonatal de prematuros de muito baixo peso em unidade de terapia intensiva. Research, society and development, v. 2021, p. 1–15.

Cupen, K. et al. (2017). Risk factors associated with preterm neonatal mortality: a case study using data from mt. Hope women’s hospital in trinidad and tobago. Children, v. 4, n. 12, p. 108.

Ellsbury, D. L. et al. (2016). A multifaceted approach to improving outcomes in the nicu: the pediatrix 100 000 babies campaign. Pediatrics, v. 137, n. 4.

Fenton, T. R.; Kim, J.H. (2013). A systematic review and meta-analysis to revise the fenton growth chart for preterm infants. Bmc pediatrics, v. 13, n. 1.

Fiorenzano, D. M. et al. (2019). Síndrome do desconforto respiratório: influência do manejo sobre o estado hemodinâmico de recém-nascidos pré-termo ≤ 32 semanas nas primeiras 24 horas de vida. Revista brasileira de terapia intensiva, v. 31, n. 3, p. 312–317.

Gagliardi, L.; Bellù, R. (2017). Extreme prematurity outcomes: have we really reached the limit? Pediatrics, v. 139, n. 3.

Gibelli, M. A. B. (2019) Cuidados paliativos em recém- nascidos: quem são esses pacientes? In: Procianoy Rs, Leone Cr (orgs). Sociedade brasileira de pediatria; Programa de atualização em neonatologia, v. Ciclo 17, p. 77–101.

Guimarães, A. L. S. (2019). Análise das malformações congênitas a partir do relacionamento das bases de dados de nascidos vivos e óbitos infantis. Revista brasileira de saúde materno infantil, v. 19, n. 4, p. 925–933.

Guimarães, E. A. de a. et al. (2017) Prevalência e fatores associados à prematuridade em divinópolis, minas gerais, 2008-2011: análise do sistema de informações sobre nascidos vivos. Epidemiologia e serviços de saúde, v. 26, n. 1, p. 91–98.

Guillén, Ú.. et al. (2019) . Evaluating the use of a decision aid for parents facing extremely premature delivery: a randomized trial. Journal of pediatrics, v. 209, p. 52- 60.

Guinsburg, r. et al. (2016). Death or survival with major morbidity in vlbw infants born at brazilian neonatal research network centers. Journal of maternal-fetal and neonatal medicine, v. 29, n. 6, p. 1005–1009.

Guinsburg, R. et. al. (2016) Reanimação do prematuro <34 semanas em sala de parto: diretrizes 2016 da sociedade brasileira de pediatria. Sociedade brasileira de pediatria, p. 1–37.

Helenius, K. et al. (2018) Survival in very preterm infants: an international comparison of 10 national neonatal networks. Obstetrical and gynecological survey, v. 73, n. 4, p. 187–189.

Henriques, L. B. et al. ( 2019). Accuracy of gestational age assessment in brazilian information system on live birth (SINASC): a population study. Cadernos de saude publica, v. 35, n. 3, p. 1–11.

Horbar, J. D. et al. (2017). Variation in performance of neonatal intensive care units in the United States. Jama Pediatrics, v. 171, n. 3, p. 1–8.

Hon, K. L. et al. (2018) Mortality and morbidity of extremely low birth weight infants in Hong Kong, 2010-2017: a single-centre review. Hong Kong Medical Journal, v. 24, n. 5, p. 460–465.

Jung, Y. H. et al. (2019). Respiratory severity score as a predictive factor for severe bronchopulmonary dysplasia or death in extremely preterm infants. BMC Pediatrics, v. 19, n. 1, p. 1–8.

Lansky, S. et al. (2014). Pesquisa nascer no Brasil: perfil da mortalidade neonatal e avaliação da assistência à gestante e ao recém-nascido. Cadernos de saúde pública, v. 30, n. Suppl 1, p. 192–207.

Leal, M. do c. et al. (2016) Prevalence and risk factors related to preterm birth in Brazil. Reproductive health, v. 13, n. Suppl 3, p. 164–174.

Lee, A. C. C.; Blencowe, H.; Lawn, J. E. (2018) Small babies, big numbers: global estimates of preterm birth preterm. The lancet global health, v. 7, n. 1, p. E2–e3.

Leuthner, S. R. (2004). Palliative care of the infant with lethal anomalies. Pediatric clinics of north america, v. 51, n. 3, p. 747–759.

Lima, R. G.; Vieira, V. C.; Medeiros, D. S. De. (2020). Determinantes do óbito em prematuros de unidades de terapia intensiva neonatais no interior do nordeste. Rev. Bras. Saúde mater. Infant., v. 20, n. 2, p. 545–554.

Li, H.-x. et al. (2021) Risk factors for respiratory assistance in premature infants. Experimental and therapeutic medicine, v. 21, n. 3, p. 1–8.

Mactier, H. et al. (2020). Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice. Archives of disease in childhood: fetal and neonatal edition, v. 105, n. 3, p. F232–f239.

Manuck, T. et al. (2016) Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. American journal of obstetrics and gynecology, v. 19(6), p. 545–554.

Marques, B. R. et al. (2019). Morbidity and mortality in preterm infants less than 29 weeks of gestational age. Journal of pediatric and neonatal individualized medicine, v. 8, n. 1, p. 1–9.

Mengistu, T. S. et al. (2021) Factors associated with increased risk of early severe neonatal morbidity in late preterm and early term infants. Journal of clinical medicine, v. 10, n. 6, p. 1319.

Moya, F. R. et al. (2019) Prospective observational study of early respiratory management in preterm neonates less than 35 weeks of gestation. BMC Pediatrics, v. 19, n. 1, p. 1–10.

Myrhaug, H. T. et al. (2019). Survival and impairment of extremely premature infants: a meta-analysis. Pediatrics, v. 143, n. 2.

OMS. 2018 mortalidade infantil no mundo. Disponível em https://www.who.int/eportuguese/publications/pt/. Acesso em: 18 nov. 2021.

Papageorghiou, A. T. (2019). And now 2020. BJOG: an international journal of obstetrics and gynaecology, v. 126, n. 13, p. 1511–1512.

Peixoto, M. et al. (2019). Avaliação da sobrevida de recém-nascidos pré-termo extremos em hospital universitário. Revista de pediatria SOPERJ, v. 19, n. 1, p. 10–15.

Pinto, F. et al. (2019). Born preterm: a public health issue. Portuguese Journal of Public Health, v. 37, n. 1, p. 38–49.

Ratnasiri, A. W. G. et al. (2018). Recent trends, risk factors, and disparities in low birth weight in California, 2005–2014: a retrospective study. Maternal Health, Neonatology and Perinatology, v. 4, n. 1, p. 1–13.

Razeq, A. et al. (2017). The incidence, risk factors, and mortality of preterm neonates: a prospective study from Jordan (2012-2013). Turk Jinekoloji ve Obstetrik Dernegi, v. 14, n. 1, p. 28–36.

Rede Brasileira De Pesquisas Neonatais -RBPN (2019). Mortalidade em recém-nascidos de muito baixo peso nos 20 centros da RBPN: 2011-2018 [cited 2019 oct 19]. Availablefrom: http://www.redeneonatal.com.br

Reyes, Jc et al. (2018). Mortalidade neonatal e fatores associados em recém-nascidos internados em unidade de terapia neonatal. Arch argent pediatr, v. 116, n. 1, p. 42-8

Roberts D., Brown J, Medley N., Dalziel Sr. (2017) Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane database syst rev. 2017; 3:cd004454https://doi.org/10.1002/14651858.cd004454.pub3.

Rodrigo, F. G.-M. et al. (2015). Changes in perinatal care and outcomes in newborns at the limit of viability in spain: the epi-sen study and the sen1500 network of the spanish neonatal society (sociedad española de neonatología). Neonatology, v. 107, n. 2, p. 120–129.

Seri, I,.; Evans, J.( 2018).Limits of viability: definition of the gray zone. Journal of perinatology, v. 28, n. June 2014, p. S4–s8.

Schneider, K. et al.(2019) End-of-life decisions 20 years after euronic: neonatologists’ self-reported practices, attitudes, and treatment choices in Germany, Switzerland, and Austria. Journal of pediatrics, v. 207, p. 154–160.

Shane, A. L.; Sánchez, p. J.; Stoll, b. J. (2017). Neonatal sepsis. The lancet, v. 390, n. 10104, p. 142.

Stanak, M.; Hawlik, K. (2019). Decision-making at the limit of viability: The Austrian neonatal choice context. BMC Pediatrics, v. 19, n. 1, p. 1–10.

Stensvold, H. J. et al. (2017). Neonatal morbidity and 1-year survival of extremely preterm infants. Pediatrics, v. 139, n. 3.

Stoll, B. J. et al. (2020). Early-onset neonatal sepsis 2015 to 2017, the rise of escherichia coli, and the need for novel prevention strategies. Jama Pediatrics, v. 174, n. 7, p. 1–12.

Sweet, D. G. et al. (2019). European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology, v. 115, n. 4, p. 432–450.

Teixeira, F. et al.(2021). Neonatal healthcare-associated infections in Brazil: systematic review and meta-analysis. Archives of public health, v. 6, p. 1–10.

Tietzmann, M. R. et al. (2020). Risk factors for neonatal mortality in preterm newborns in the extreme south of Brazil. Scientific Reports, v. 10, n. 1, p. 1–7.

Veloso, F. C. S. et al. (2019). Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta‐analysis of observational studies. Jornal de Pediatria (versão em português), v. 95, n. 5, p. 519–530..

Vilanova, C. S. et al. (2019). The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil. Population health metrics, v. 17, n. 1, p. 1–12.

Vogel, J. P. et al. (2018). The global epidemiology of preterm birth. Best practice and research: clinical obstetrics and gynaecology, v. 52, n. April, p. 3–12,

Vogel, J. P.; Chawanpaiboon, S.; Gülmezoglu, A. M. (2019) Reducing the global burden of disease in childhood. The lancet global health, v. 7, n. 4, p. E416.

Wang, M. L. et al. (2004). Clinical outcomes of near-term infants. Pediatrics, United States, v. 114, p. 372–376.

Who. (2004). World health organization. The prevention of perinatal morbidity and mortality. 22 de abril de 1969. Disponível em: http://apps.who.int/iris/bitstream/10665/62928/1/who_php_42.pdf. Acesso em: 20 nov. 2021

Wilkinson, Dominic & Stenson, Ben. (2015). Don't stop now? How long should resuscitation continue at birth in the absence of a detectable heartbeat? Archives of disease in childhood. Fetal and neonatal edition. 100. 10.1136/archdischild-2015-308602.

Wyckoff, M. H. et al. (2020) Neonatal life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. [s.l: s.n.]. V. 142.

Wyllie, J. et al. (2015). Part 7: neonatal resuscitation. 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation, v. 95, p. E169–e201, 1 out. 2015.

Yeo, k. T. et al. (2017). Prediction of outcomes of extremely low gestational age newborns in Australia and New Zealand. BMJ Pediatrics Open, v. 1, n. 1, 2.



How to Cite

LARANJEIRA, P. F. M.; SANTOS, V. de C. B. dos; NOGUEIRA, J. da S.; LARANJEIRA, A. C. M.; AMORIM, G. M.; LARANJEIRA, R. M.; BARBOSA, K. G. N. . Extreme prematurity in a public reference unit: morbidity, viability and mortality. Research, Society and Development, [S. l.], v. 11, n. 6, p. e58311629468, 2022. DOI: 10.33448/rsd-v11i6.29468. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/29468. Acesso em: 14 jun. 2024.



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