Apgar menor que 7 no 5º minuto de vida: de 1999 a 2019, o que mudou? Estudo populacional com base no sistema de informações de nascidos vivos

Abstract

Brazil has a high rate of perinatal mortality and morbidity. Unlike developed countries, in Brazil most perinatal deaths are determined by conditions of the pregnant woman, characteristics of childbirth and newborn care. Despite interobserver variation in the assessment of the Apgar score, it remains a useful indicator of the newborn's overall condition. The objective of this study is to describe the rate of Apgar score lower than 7 in the 5th minute of life in the years 2018 and 2019, comparing it with the rate of Apgar score lower than 7 in the 5th minute of life in 1999, and describe risk factors associated with the outcome. This is a cross-sectional study based on the population of live births in Brazil in 1999 and in the 2018-2019 biennium. All live birth certificates (DNV) obtained from the Live Births System database were evaluated. Frequencies were compared between groups using Pearson's chi-square test and multivariate logistic regression analysis was performed. A statistical significance level of 0.05 was adopted. 9,050,521 DNVs were analyzed in our research. We found that 2.1% of newborns had a 5-minute Apgar < 7 in 1999 compared to 0.9% in 2018-2019. The multivariate analysis indicated that twins and teenage pregnancy are no longer risk factors for an Apgar score of 5 minutes < 7. Among the risk factors, there is an increase in prematurity, low birth weight and congenital anomalies. An improvement in maternal markers was observed, in particular an increase in maternal age, in the level of schooling and improvement in prenatal coverage in all regions of the country, most notably in the North and Northeast regions. These findings demonstrate that social factors are central elements in determining the patterns of morbidity and mortality in societies and that the impairment of the population's living conditions is reflected in the prevalence of unfavorable gestational outcomes.