In these circumstances, they require appropriate and effective care, one of the current proposals of the Stork Network.15 The odds of neonatal mortality were higher in the group of mothers with inadequate prenatal care, showing how health care during pregnancy plays an important role in the studied outcome, a result consistent with other studies.2, 3 and 18 In Brazil, the coverage and the mean number of consultations during prenatal care show a growing trend. The assessment of prenatal care quality is not available in many studies in which the outcome is mortality, but there is evidence that poor-quality care selleck compound is a more serious problem than simply fewer consultations.7 and 26

Adequate prenatal care has emerged as a key protective factor against low birth weight, prematurity, intrauterine growth retardation, and neonatal death.2 and 15 Good-quality care during the prenatal period can result in a reduction of 10% to 20% of all deaths in the neonatal period.27 The lack of ultrasound examination was also a risk factor, which may serve as a warning, at the admission of pregnant women in labor, that there were limitations in the prenatal care; moreover, Baf-A1 nmr the early identification and diagnosis of morphological fetal and placental alterations observed in the ultrasound help to recognize risks and may reduce neonatal

mortality. A large number of births occur in hospitals that are not capable of safely meeting mothers’ and newborns’ necessities,10 and 11 and thus the transfer to

another unit (sometimes inappropriately performed) indicated a greater chance of death. In this study, over 70% of children who were transferred were born in private maternity hospitals that provide assistance to the SUS (data not shown). This result may indicate risk of stillbirth due to poor-quality care, as well as difficulty in accessing good quality Phloretin health services. Public hospitals with intensive and intermediate neonatal care units, when compared with private hospitals that have contracts with SUS, present better results in relation to risk of death.4, 10 and 11 A longer period of time between admission and delivery (≥ 10 hours) influenced the occurrence of neonatal deaths, similar to other study carried out in Northeastern Brazil.3 Although obstetric complications and lack of NICU availability delayed the hospitalization of pregnant women in appropriate units, the factor that most influenced neonatal survival was timely care, showing an unsatisfactory monitoring of labor. As expected, the studied infants admitted at NICUs were those who had a greater chance of death. However, studies have shown that Brazilian newborns, when admitted at NICU, are more likely to die when compared to those in developed countries with the same problems, suggesting deficiencies in care.