Preterm birth and neonatal mortality in a rural Bangladeshi cohort: implications for health programs.

ABSTRACT

OBJECTIVE: To estimate the burden of prematurity, determine gestational age (GA)-specific neonatal mortality rates and provide recommendations for country programs. STUDY DESIGN: Prospective data on pregnancy, childbirth, GA and newborn mortality collected by trained community health workers from 10 585 mother-newborn pairs in a community-based study. RESULT: A total of 19.4% of newborn infants were preterm; 13.5% were late preterm (born between 34 and 36 weeks of gestation), 3.3% were moderate preterm (born at 32 to 33 weeks) and 2.6% were extremely preterm (born at 28 to 31 weeks of gestation). Preterm babies experienced 46% of all neonatal deaths; 40% of preterm deaths were in late preterm, 20% in moderate preterm and 40% in very preterm infants. The population attributable fraction of neonatal mortality in premature babies was 0.16 for very preterm, 0.07 for moderately preterm and 0.10 for late preterm. CONCLUSION: In settings where the majority of births and newborn deaths occur at home and successful referral is a challenge, moderate and late preterm babies may be an important target group for home-based or first-level facility-based management.