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Made available in DSpace on 2022-04-29T08:29:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: The effects of antenatal corticosteroids (ANSs) on twins are not well established. Objective: To determine the impact of ANS use according to the number of fetuses. Methods: Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014. Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. Results: About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R 2 Twins = 0.78; 95% CI = 0.69–0.86) (Adj R 2 Singles = 0.79; 95% CI = 0.62–0.99). Reduced peri-intraventricular hemorrhage (Adj R 2 Twins = 0.54; 95% CI = 0.36–0.78) (Adj R 2 singles = 0.54; 95% CI = 0.36–0.78); and early sepsis reduction on single and triplex gestations (Adj R 2 triplex = 0.51; 95% CI = 0.27–0.94) (Adj single R 2 = 0.51; 95% CI = 0.27–0.94) were observed. Conclusions: This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations. Department of Pediatrics Ribeirão Preto Medical School University of São Paulo Department of Pediatrics Oswaldo Cruz Foundation Fernandes Figueira Institute Department of Pediatrics Federal University of Rio Grande do Sul Porto Alegre Clinic Hospital Department of Pediatrics Universitary Hospital Pedro Rio de Janeiro State University Department of Pediatrics Federal University of Minas Gerais Department of Pediatrics Federal University of Uberlandia Department of Pediatrics Faculty of Medical Sciences of Minas Gerais Department of Pediatrics Sumare State Hospital State University of Campinas Pirajussara State Hospital Department of Pediatrics Federal University of São Paulo State Hospital Diadema Neonatal Unit São Paulo Federal University Department of Pediatrics Londrina State University Health Sciences Center Department of Pediatrics Federal University of Parana Department of Pediatrics Professor Fernando Figueira Institute of Integral Medicine Department of Pediatrics University Hospital of the Federal University of Maranhão Department of Pediatrics Botucatu Medical School- São Paulo State University Julio de Mesquita Neto Department of Pediatrics Federal University of São Paulo Department of Pediatrics Children’s Institute São Paulo Medical School University of São Paulo Department of Pediatrics University Hospital São Paulo Medical School University of São Paulo Department of Pediatrics Pontifical Catholic University of Rio Grande do Sul Department of Pediatrics Campinas State University Department of Pediatrics Botucatu Medical School- São Paulo State University Julio de Mesquita Neto

Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions.Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients.In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions.Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS.· Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..

Made available in DSpace on 2018-11-26T17:55:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-03-18 Health Ministry of Brazil (Ministerio da Saude do Brasil) Objective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.Methods: Prospective cohort of 2646 inborn infants with gestational age 23-33 weeks and birth weight 400-1499g, without malformations, born at 20 centers in 2012-2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with 1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3-4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3-4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55-0.88), C-section (0.72; 0.58-0.90), gestational age

Made available in DSpace on 2018-11-26T15:46:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Objective To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. Design Pragmatic prospective cohort study. Setting 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. Interventions Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalada. Logistic regression adjusted for confounding variables was applied for main outcome. Results 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 +/- 277 vs 941 +/- 279 g, gestational age 28.2 +/- 2.5 vs 27.8 +/- 2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%, Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% Cl 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). Conclusion This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates. Univ Fed Sao Paulo, Div Neonatal Med, Sao Paulo, Brazil Univ Sao Paulo, Dept Pediat, Fac Med Ribeirao Preto, Ribeirao Preto, Brazil Univ Fed Maranhao, Dept Pediat, Sao Luis, Brazil Univ Estadual Campinas, Dept Pediat, Fac Ciencias Med, Campinas, SP, Brazil Univ Sao Paulo, Dept Pediat, Fac Med, Sao Paulo, Brazil Univ Estadual Paulista, Div Neonatol, Fac Med Botucatu, Botucatu, SP, Brazil Fundacao Oswaldo Cruz, Div Neonatol, Rio De Janeiro, Brazil Pontificia Univ Catolica Rio Grande do Sul, Dept Pediat, Hosp Sao Lucas, Fac Med, Porto Alegre, RS, Brazil Univ Fed Rio Grande do Sul, Div Neonatol, Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil Univ Estado Rio de Janeiro, Dept Pediat, Hosp Univ Pedro Ernesto, Rio De Janeiro, Brazil Univ Fed Minas Gerais, Div Neonatol, Belo Horizonte, MG, Brazil Univ Fed Uberlandia, Pediat, Uberlandia, MG, Brazil Maternidade Hilda Brandao, Dept Pediat, Fac Ciencias Med Minas Gerais, Belo Horizonte, MG, Brazil Univ Sao Paulo, Sch Med, Dept Pediat, Sao Paulo, SP, Brazil Hosp Estadual Sumare, Neonatal Div, Sumare, Brazil Hosp Geral Pirajussara, Neonatal Unit, Taboao Da Serra, Brazil Hosp Estadual Diadema, Neonatal Unit, Diadema, Brazil Univ Estadual Londrina, Dept Pediat, Hosp Univ, Curitiba, Parana, Brazil Univ Fed Parana, Dept Pediat, Hosp Clin, Curitiba, Parana, Brazil Inst Med Integral Prof Fernando Figueira, Dept Pediat, Recife, PE, Brazil Inst Fernandes Figueira FIOCRUZ, Dept Pediat, Rio De Janeiro, Brazil Univ Estadual Paulista, Div Neonatol, Fac Med Botucatu, Botucatu, SP, Brazil

The causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P < 0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.

Em uma perspectiva mundial, nascem em torno de 15 milhoes de RN prematuros (

Made available in DSpace on 2015-02-02T12:39:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-12-01Bitstream added on 2015-02-02T13:07:52Z : No. of bitstreams: 1 S0021-75572014000600616.pdf: 538774 bytes, checksum: f77d33775a668b04ad4851c5a1d3e6fc (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Objetivo Analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém-nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de Pesquisas Neonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragia intraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolite necrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP. Métodos Estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo RN de 16 UN da RBPN de 01/01/2010 a 31/12/2011, PN < 1.000 g, idade gestacional (IG) < 33 semanas e diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro dia de vida, infecções congênitas ou malformações. Grupos: G1 – conservadora (sem intervenção medicamentosa ou cirúrgica), G2 – farmacológica (indometacina ou ibuprofeno) e G3 – cirúrgico (com ou sem tratamento farmacológico anterior). Analisou-se: uso de esteroide antenatal, parto cesárea, PN, IG, Apgar5′ < 4, sexo masculino, SNAPPE II, síndrome do desconforto respiratório (SDR), sepse tardia, ventilação mecânica (VM), surfactante < 2 horas de vida, tempo de VM e os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), HIV III/IV, ROPcir, ECNcir e óbito/DBP36s. Estatística: Teste t-Student, Qui-Quadrado ou teste Exato de Fisher. Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (Medical Calculator) software, versão 12.1.4.0.p < 0,05. Resultados Foram selecionados 1.097 RN e 494 foram incluídos: G1-187 (37,8%), G2-205 (41,5%) e G3-102 (20,6%). Verificou-se: maior mortalidade (51,3%) no G1 e menor no G3(14,7%); maior frequência DBP36s (70,6%) e ROPcir (23,5%) no G3; maior frequência de óbito/DBP36s no G2 (58,0%). As abordagens farmacológica (OR-0,29; 95%, IC-0,14-0,62) e conservadora (OR-0,34; 95%, IC- 0,14-0,79) foram protetoras somente para o desfecho óbito/DBP36sem. Conclusão Em RN com PCA, a abordagem conservadora relacionou-se à maior mortalidade, a cirúrgica à ocorrência de DBP36s e ROPcir., enquanto o tratamento farmacológico mostrou-se protetor para o desfecho óbito/DBP36sem. Objective: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g) with patent ductus arteriosus (PDA), from the Brazilian Neonatal Research Network (BNRN) on: death, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH III/IV), retinopathy of prematurity requiring surgical (ROPsur), necrotizing enterocolitis requiring surgery (NECsur), and death/BPD. Methods: This was a multicentric, cohort study, retrospective data collection, including newborns (BW < 1000 g) with gestational age (GA) < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 – conservative approach (without treatment), G2 – pharmacologic (indomethacin or ibuprofen), G3 – surgical ligation (independent of previous treatment). Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II), respiratory distress syndrome (RDS), late sepsis (LS), mechanical ventilation (MV), surfactant (< 2 h of life), and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks), IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI); logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator) software, version 12.1.4.0. p-values < 0.05 were considered statistically significant. Results: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%), G2 - 205 (41.5%), and G3 - 102 (20.6%). The highest mortality was observed in G1 (51.3%) and the lowest in G3 (14.7%). The highest frequencies of BPD36wks (70.6%) and ROPsur were observed in G3 (23.5%). The lowest occurrence of death/BPD36wks occurred in G2 (58.0%). Pharmacological (OR 0.29; 95% CI: 0.14-0.62) and conservative (OR 0.34; 95% CI: 0.14-0.79) treatments were protective for the outcome death/BPD36wks. Conclusion: The conservative approach of PDA was associated to high mortality, the surgical approach to the occurrence of BPD36wks and ROPsur, and the pharmacological treatment was protective for the outcome death/BPD36wks. Universidade de São Paulo Faculdade de Medicina Universidade de São Paulo Faculdade de Medicina Department of Pediatrics Universidade Federal do Rio Grande do Sul Faculdade de Medicina Department of Pediatrics and Child Care Universidade Estadual de Campinas Faculdade Ciências Médicas Department of Pediatrics Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Department of Pediatrics Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Pediatrics Instituto Fernandes Figueira Fundação Oswaldo Cruz (FIOCRUZ) Department of Neonatology Pontifícia Universidade Católica do Rio Grande do Sul Faculdade de Medicina Department of Pediatrics Universidade Estadual de Londrina Faculdade de Medicina Instituto de Medicina Integral Prof. Fernando Figueira Universidade Federal do Paraná Department of Pediatrics Universidade Federal de Uberlândia Universidade Estadual do Rio de Janeiro Universidade Federal do Maranhão Universidade Federal de Minas Gerais Faculdade de Ciências Médicas de Minas Gerais Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Pediatrics

Made available in DSpace on 2015-12-07T15:37:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-09-04. Added 1 bitstream(s) on 2015-12-07T15:54:26Z : No. of bitstreams: 1 PMC4560891.pdf: 546239 bytes, checksum: cbc40d116ccd55d2a1b852068086634a (MD5) Ministry of Health of Brazil Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. A prospective cohort of 4283 preterm infants (gestational age: 29.9 ± 2.9 weeks; birth weight: 1084 ± 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. A total of 2208 (51.6%) infants received RBC transfusions (variation per neonatal unit: 34.1% to 66.4%). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95%CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), >60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants. Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil Universidade Estadual Paulista (UNESP), Botucatu, SP, Brasil Instituto Nacional de Saúde da Mulher, Criança e Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil Universidade Estadual de Londrina (UEL), Londrina, PR, Brasil Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil Universidade Federal de Uberlândia (UFU), Belo Horizonte, MG, Brasil Universidade do Estado de Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil Universidade Federal do Maranhão (UFMA), São Luís, MA, Brasil Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brasil Universidade de São Paulo (USP), São Paulo, SP, Brasil Universidade Estadual Paulista (UNESP), Botucatu, SP, Brasil Ministry of Health of Brazil: 1755/2000

This study was a comparison of neonatal mortality rates in four maternity hospitals in the city of Rio de Janeiro, Brazil. The study population consisted of newborns with birth weight below 1,500 g. The research instrument was a questionnaire with data reported by the mother and collected from the patient record. For each maternity hospital the standardized mortality ratio (SMR) was calculated using the direct and indirect method, using the weight distribution of the National Institute of Child Health and Human Development Neonatal Research as the standard. The final sample consisted of 487 newborns. Standardizations by the direct and indirect method showed high mortality rates in all four institutions; those showing the largest number of newborns in the lowest weight brackets were those with the lowest SMR values. The lowest mortality ratio by weight bracket was in the 500 to 749 g group. The SMR results were inversely associated with the quantitative population of newborns in the lowest weight brackets. The mortality coefficients showed high rates, especially in the highest weight brackets. The results indicate deficient quality of perinatal care.

The objective of this study was to describe the causes of neonatal mortality in four maternity hospitals in the Municipality of Rio de Janeiro, Brazil. The study included all very low birth weight newborns during the first complete 27 days of life. The distribution of live newborns and all very low birth weight newborns as well as the percentage of deaths per hospital and the totals were described. The study estimated total and specific neonatal mortality coefficients and assessed viability, time, and causes of death. The study sample consisted of 487 newborns. We found an 11.3 neonatal mortality rate (8.3 early neonatal and 2.9 late neonatal). Viability for all very low birth weight newborns was above 26 weeks' gestation and birth weight of 749 g. Mortality was low in the first three days of life, mainly in the first day, and higher from the fourth to the 28th day. Sepsis was the main cause of neonatal mortality. Health systems managers should focus on: diagnosis and control of perinatal infections; decreasing neonatal hospital infection by reducing overcrowding in the nursery; and routine pathological investigation on all placentas in very low birth weight newborns as well as routine autopsies in case of death.

O objetivo foi descrever as causas de morte em recém-nascidos de muito baixo peso, em quatro maternidades do Município do Rio de Janeiro, Brasil. No estudo longitudinal foram incluídos todos os recém-nascidos de muito baixo peso até completarem 27 dias de vida. Descrita a distribuição dos recém-nascidos vivos, recém-nascidos de muito baixo peso, percentual de óbitos por maternidades e o seu total, foram calculados os coeficientes de mortalidade neonatal total e seus componentes. Viabilidade e tempo de mortes foram avaliados. O estudo incluiu 487 recém-nascidos. A mortalidade neonatal foi de 11,3?, a precoce de 8,3? e a tardia de 2,9?. A viabilidade de recém-nascidos de muito baixo peso foi superior a 26 semanas gestacionais e 749g de peso. A mortalidade foi baixa nos primeiros três dias de vida, especialmente no 1masculine, e elevada do 4masculine ao 28masculine. Principal causa da morte foi a sepsis. As ações dos gestores de saúde devem ser direcionadas na melhoraria do diagnóstico; controle das infecções perinatais; diminuição da contaminação hospitalar dos recém-nascidos, com redução da superpopulação nas enfermarias; estudo rotineiro das placentas e necropsia de recém-nascidos de muito baixo peso.

In Brazil, neonatal mortality is the most common cause of infant mortality. The majority of deaths occur in very low birthweight newborns. This longitudinal study assesses factors associated with mortality risk in very low birthweight newborns during the first 27 days of life. Relative risk of mortality was assessed for each variable, and the most statistically significant variables were selected for the multivariate model, in which odds ratios were calculated using logistic regression. Factors associated with decreased mortality risk were: prenatal corticosteroid (OR = 0.40; 90%CI: 0.23-0.74) and total parenteral nutrition (OR = 0.06; 90%CI: 0.02-0.15). Factors associated with increased mortality risk were: male gender (OR = 2.19; 90%CI: 1.27-4.00); maternal hemorrhage (OR = 4.28; 90%CI: 1.27-14.46); use of mechanical ventilation (OR = 18.83; 90%CI: 5.15-68.87); CRIB (OR = 4.48; 90%CI: 2.43-8.27); and birthweight. Selective use of prenatal corticosteroid should be encouraged in order to reduce neonatal mortality and morbidity.