Painel de monitoramento do NMN em Sergipe: subsídios para redução da mortalidade infantil

Abstract

Introduction: Neonatal NMN (NNM) is an important indicator of severe neonatal morbidity and contributes to understanding the determinants of infant mortality. The analysis of cases that nearly resulted in death but survived makes it possible to identify weaknesses and strengths in maternal and child healthcare. In the state of Sergipe, systematic monitoring of this outcome is still limited, hindering the implementation of prevention strategies. Objective: To monitor NNM cases in Sergipe, identifying epidemiological patterns, associated risk factors, and priority areas for intervention. Methods: A descriptive study based on secondary data from the Live Birth Information System (SINASC), referring to all live births in Sergipe between 2011 and 2023. The definition of NNM followed pragmatic criteria widely used in the literature: Apgar score < 7 at the 5th minute, birth weight < 1500 g, and gestational age (GA) < 32 weeks. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated, analyzing maternal, gestational, neonatal, and obstetric variables. For the development of the interactive dashboard, functionalities provided by Streamlit version 1.51.0 and the Python programming language version 3.14 were used through a virtual environment (venv). Results: The prevalence of NNM in the state of Sergipe was 14,200 cases, with a rate of 33.7 NNM per thousand live births, and the municipality of Malhada dos Bois presented the highest NNM rate. Lack of prenatal care was the factor most strongly associated with the outcome, while having seven or more prenatal visits showed a consistent protective effect. Low educational level, single marital status, and prematurity also stood out as significant determinants. Higher risk was identified among male neonates, multiple pregnancies, non-cephalic fetal presentations, births outside the hospital setting, and the presence of congenital anomalies. Neonates classified as NNM presented worse Apgar scores, lower birth weight, and reduced gestational age. Conclusion: The findings reveal that NNM in Sergipe is a multifactorial event, strongly influenced by biological conditions, social determinants, and characteristics of healthcare services. Lack of prenatal care, multiple pregnancies, and out-of-hospital births constitute the main risk factors. The results reinforce the need to strengthen prenatal care policies, expand access to safe childbirth, and improve the quality of neonatal care.