{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:45:23Z","timestamp":1777074323231,"version":"3.51.4"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"crossref","award":["2017\/03748-7"],"award-info":[{"award-number":["2017\/03748-7"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Population-based studies analyzing neonatal deaths in middle-income countries may contribute to design interventions to achieve the Sustainable Development Goals, established by United Nations. This study goal is to analyze the annual trend of neonatal mortality in S\u00e3o Paulo State, Brazil, over a 10-year period and its underlying causes and to identify maternal and neonatal characteristics at birth associated with neonatal mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A population-based study of births and deaths from 0 to 27\u00a0days between 2004 and 2013\u00a0in S\u00e3o Paulo State, Brazil, was performed. The annual trend of neonatal mortality rate according to gestational age was analyzed by Poisson or by Negative Binomial Regression models. Basic causes of neonatal death were classified according to ICD-10. Association of maternal demographic variables (block 1), prenatal and delivery care variables (block 2), and neonatal characteristics at birth (block 3) with neonatal mortality was evaluated by Poisson regression analysis adjusted by year of birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 6,056,883 live births in S\u00e3o Paulo State during the study period, 48,309 died from 0 to 27\u00a0days (neonatal mortality rate: 8.0\/1,000 live births). For the whole group and for infants with gestational age 22\u201327, 28\u201331, 32\u201336, 37\u201341 and \u2265\u200942 weeks, reduction of neonatal mortality rate was, respectively, 18\u2009%, 15\u2009%, 38\u2009%, 53\u2009%, 31\u2009%, and 58\u2009%. Median time until 50\u2009% of deaths occurred was 3\u00a0days. Main basic causes of death were respiratory disorders (25\u2009%), malformations (20\u2009%), infections (17\u2009%), and perinatal asphyxia (7\u2009%). Variables independently associated with neonatal deaths were maternal schooling, prenatal care, parity, newborn sex, 1st minute Apgar, and malformations. Cesarean delivery, compared to vaginal, was protective against neonatal mortality for infants at 22\u201331 weeks, but it was a risk factor for those with 32\u201341 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the significant decrease in neonatal mortality rate over the 10-year period in S\u00e3o Paulo State, improved access to qualified health care is needed in order to avoid preventable neonatal deaths and increase survival of infants that need more complex levels of assistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-021-02511-8","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:13:22Z","timestamp":1611620002000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Annual trend of neonatal mortality and its underlying causes: population-based study \u2013 S\u00e3o Paulo State, Brazil, 2004\u20132013"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1967-9861","authenticated-orcid":false,"given":"Ruth","family":"Guinsburg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1187-0143","authenticated-orcid":false,"given":"Adriana","family":"Sanudo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1122-0693","authenticated-orcid":false,"given":"Carlos Roberto V","family":"Kiffer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9845-6097","authenticated-orcid":false,"given":"Ana S\u00edlvia S","family":"Marinonio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7629-4904","authenticated-orcid":false,"given":"Daniela T","family":"Costa-Nobre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7801-757X","authenticated-orcid":false,"given":"Kelsy N","family":"Areco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5230-1989","authenticated-orcid":false,"given":"Mandira D","family":"Kawakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4935-6505","authenticated-orcid":false,"given":"Milton H","family":"Miyoshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-3970","authenticated-orcid":false,"given":"Paulo","family":"Bandiera-Paiva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7553-466X","authenticated-orcid":false,"given":"Rita de C\u00e1ssia X","family":"Balda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-9692","authenticated-orcid":false,"given":"Tulio","family":"Konstantyner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5631-9924","authenticated-orcid":false,"given":"Liliam CC","family":"Morais","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4266-6110","authenticated-orcid":false,"given":"Rosa MV","family":"Freitas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7571-8154","authenticated-orcid":false,"given":"M\u00f4nica LP","family":"Teixeira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5267-7361","authenticated-orcid":false,"given":"Bernadette","family":"Waldvogel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5864-3808","authenticated-orcid":false,"given":"Maria Fernanda B","family":"Almeida","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,26]]},"reference":[{"key":"2511_CR1","doi-asserted-by":"publisher","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","volume":"388","author":"L Liu","year":"2016","unstructured":"Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. 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All data used in the research was provided by Funda\u00e7\u00e3o SEADE, the public state institution responsible for gathering demographic data of Live Births Certificates and Death Certificates of S\u00e3o Paulo State, Brazil. Administrative permission to use the database was provided by Funda\u00e7\u00e3o SEADE.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication for participants in the study"}},{"value":"This manuscript is being submitted only to <i>BMC Pediatrics<\/i> and it will not be submitted elsewhere while under consideration. All authors listed on the manuscript approved the submission of this version of the manuscript and take full responsibility for the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Nothing to declare. Database use was possible due to FAPESP (Grant # 2017\/03748-7) and due to agreements #23089.004297\/2008-11 and #23089.000057\/2014-95 between Funda\u00e7\u00e3o SEADE and Universidade Federal de S\u00e3o Paulo.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"54"}}