Factors associated with neonatal near miss in the Southeastern region of Brazil: results from Birth in Brazil II

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Abstract
This article aims to analyze the factors associated with neonatal near miss (NMN) in public and private hospitals in the Southeast region of Brazil. A prospective cohort study with 7,552 live births from singleton pregnancies from the “Born in Brazil II” study (2021-2023). NMN was defined according to the criteria of Pileggi-Castro et al. (2014), and the independent variables were organized in a hierarchical model: distal level (sociodemographic characteristics), intermediate level (maternal conditions and prenatal care), and proximal level (obstetric complications, type of delivery, and sex of the newborn). Neonatal mortality (NMN) occurred in 12.5% of live births. After adjustment, the following were associated with the outcome: urban residence (OR=1.75), absence of a partner (OR=1.36), hypertensive syndromes of pregnancy, pre-gestational diabetes (OR=2.76), syphilis (OR=5.44), less than 50% of prenatal visits (OR=2.14), alcoholism (OR=1.50), severe maternal morbidity (OR=1.96), forceps/vacuum delivery (OR=2.39), and male sex (OR=1.23). NMN was associated with clinical, sociodemographic, and care determinants, highlighting persistent inequalities in prenatal and intrapartum care and the need to strengthen integrated maternal and neonatal care policies.

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