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. 2022 May 1;115(5):1334-1343.
doi: 10.1093/ajcn/nqab432.

Birth anthropometry predicts neonatal and infant mortality in rural Bangladesh: a focus on circumferential measurements

Yunhee Kang  1 , Lee Shu Fune Wu  1 , Saijuddin Shaikh  2 , Hasmot Ali  2 , Abu Ahmed Shamim  2   3 , Parul Christian  1 , Alain Labrique  1 , Keith P West  1
Affiliations

Birth anthropometry predicts neonatal and infant mortality in rural Bangladesh: a focus on circumferential measurements

Yunhee Kang et al. Am J Clin Nutr. .

Abstract

Background: Low birth weight predicts risk of infant death. However, several birth measurements may be equally predictive, for which cutoffs and associated risks are less explored.

Objectives: We assessed and optimized population cutoffs of birth length, weight, and midupper arm circumference (MUAC), head circumference (HC), and chest circumference (CC) for predicting neonatal (≤28 d) and infant (≤365 d) mortality in northwest Bangladesh.

Methods: Among 28,026 singletons born in an antenatal micronutrient supplement trial, 21,174 received anthropometry ≤72 h after birth, among whom 583 died in infancy. Optimization for predicting mortality for each measurement was guided by the Youden Index (sensitivity + specificity - 1). Relative risk ratios (RRRs) and positive predictive values (PPVs) were calculated across cutoff ranges for individual and any pair of measurements.

Results: Optimal cutoffs, harmonized to 100-g or 0.5-cm readings, for neonatal and infant mortality were 44.5 cm for length, 2200 g for weight, 9.0 cm for MUAC, 31.0 cm for HC, and 28.5 cm for CC, below which all predicted mortality. However, a CC <28.5 cm, alone and combined with HC <31.0 cm, yielded the highest RRR [9.68 (95% CI: 7.84, 11.94) and 15.74 (95% CI: 12.54, 19.75), respectively] and PPV (11.3% and 10.7%) for neonatal mortality and highest RRR [6.02 (95% CI: 5.15, 7.02) and 9.19 (95% CI: 7.72, 10.95)] and PPV (16.3% and 14.5%) for infant mortality. Pairs of measurements revealed a higher RRR for neonatal and infant mortality than individual measurements of any one pair, although the ranges of PPV remained comparable.

Conclusions: In Bangladesh, multiple birth measurements alone or in combination, particularly chest circumference, predict neonatal and infant mortality.

Keywords: birth anthropometry; infant mortality; neonatal mortality; newborn circumferential measurements; predictors.

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Figures

FIGURE 1
FIGURE 1
Maternal multiple micronutrient compared with iron–folic acid supplementation trial (JiVitA-3), Gaibandha, Bangladesh, 2008–2012.
FIGURE 2
FIGURE 2
Receiver operating characteristic (ROC) for birth anthropometric measures as predictors of (A) neonatal and (B) infant mortality in singletons measured ≤72 h after birth (n = 21,174). CC, chest circumference; HC, head circumference; MUAC, midupper arm circumference.
FIGURE 3
FIGURE 3
Nelson–Aalen cumulative hazard curves for infants through age 12 mo (365 d) by harmonized cutoffs at birth for length, weight, and midupper arm circumference (MUAC), head circumference (HC), and chest circumference (CC).
See this image and copyright information in PMC

Comment in

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