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Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017.
Hazel, Elizabeth A; Erchick, Daniel J; Katz, Joanne; Lee, Anne C C; Diaz, Michael; Wu, Lee S F; West, Keith P; Shamim, Abu Ahmed; Christian, Parul; Ali, Hasmot; Baqui, Abdullah H; Saha, Samir K; Ahmed, Salahuddin; Roy, Arunangshu Dutta; Silveira, Mariângela F; Buffarini, Romina; Shapiro, Roger; Zash, Rebecca; Kolsteren, Patrick; Lachat, Carl; Huybregts, Lieven; Roberfroid, Dominique; Zhu, Zhonghai; Zeng, Lingxia; Gebreyesus, Seifu H; Tesfamariam, Kokeb; Adu-Afarwuah, Seth; Dewey, Kathryn G; Gyaase, Stephaney; Poku-Asante, Kwaku; Boamah Kaali, Ellen; Jack, Darby; Ravilla, Thulasiraj; Tielsch, James; Taneja, Sunita; Chowdhury, Ranadip; Ashorn, Per; Maleta, Kenneth; Ashorn, Ulla; Mangani, Charles; Mullany, Luke C; Khatry, Subarna K; Ramokolo, Vundli; Zembe-Mkabile, Wanga; Fawzi, Wafaie W; Wang, Dongqing; Schmiegelow, Christentze; Minja, Daniel; Msemo, Omari Abdul; Lusingu, John P A.
Affiliation
  • Hazel EA; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Erchick DJ; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Katz J; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Lee ACC; Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Diaz M; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Wu LSF; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • West KP; Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Shamim AA; BRAC JP Grant School of Public Health, Dhaka, Bangladesh.
  • Christian P; Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Ali H; JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh.
  • Baqui AH; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Saha SK; Child Health Research Foundation, Dhaka, Bangladesh.
  • Ahmed S; Projahnmo Research Foundation, Dhaka, Bangladesh.
  • Roy AD; Projahnmo Research Foundation, Dhaka, Bangladesh.
  • Silveira MF; Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil.
  • Buffarini R; Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil.
  • Shapiro R; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Zash R; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Kolsteren P; Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
  • Lachat C; Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
  • Huybregts L; Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
  • Roberfroid D; Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA.
  • Zhu Z; Namur University, Namur, Belgium.
  • Zeng L; Belgian Health Care Knowledge Centre, Brussels, Belgium.
  • Gebreyesus SH; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
  • Tesfamariam K; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
  • Adu-Afarwuah S; Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
  • Dewey KG; Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
  • Gyaase S; Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
  • Poku-Asante K; Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA.
  • Boamah Kaali E; Kintampo Health Research Centre, Kintampo, Ghana.
  • Jack D; Kintampo Health Research Centre, Kintampo, Ghana.
  • Ravilla T; Kintampo Health Research Centre, Kintampo, Ghana.
  • Tielsch J; Research and Development Division, Ghana Health Service, Accra, Ghana.
  • Taneja S; Columbia University's Mailman School of Public Health, New York, New York, USA.
  • Chowdhury R; Aravind Eye Hospital, Madurai, India.
  • Ashorn P; George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.
  • Maleta K; Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
  • Ashorn U; Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
  • Mangani C; Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.
  • Mullany LC; School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Khatry SK; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
  • Ramokolo V; School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Zembe-Mkabile W; International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Fawzi WW; NNIPS, Kathmandu, Nepal.
  • Wang D; HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
  • Schmiegelow C; Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA.
  • Minja D; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
  • Msemo OA; College Graduate of Studies, University of South Africa, Pretoria, South Africa.
  • Lusingu JPA; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
BJOG ; 2024 Jan 16.
Article in En | MEDLINE | ID: mdl-38228570
ABSTRACT

OBJECTIVE:

To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017.

DESIGN:

Descriptive multi-country secondary data analysis.

SETTING:

Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Liveborn infants from 15 population-based cohorts.

METHODS:

Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term ≥42+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks. MAIN OUTCOME

MEASURES:

Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births).

RESULTS:

We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality.

CONCLUSIONS:

In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Etiology_studies / Prognostic_studies / Risk_factors_studies Language: En Journal: BJOG Journal subject: GINECOLOGIA / OBSTETRICIA Year: 2024 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Etiology_studies / Prognostic_studies / Risk_factors_studies Language: En Journal: BJOG Journal subject: GINECOLOGIA / OBSTETRICIA Year: 2024 Document type: Article Affiliation country: Country of publication: