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. 2023 May 8.
doi: 10.1111/1471-0528.17518. Online ahead of print.

Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017

Elizabeth A Hazel  1 , Daniel J Erchick  1 , Joanne Katz  1 , Anne C C Lee  2 , Michael Diaz  1 , Lee S F Wu  1 , Keith P West Jr  3 , Abu Ahmed Shamim  4 , Parul Christian  3 , Hasmot Ali  5 , Abdullah H Baqui  6 , Samir K Saha  7 , Salahuddin Ahmed  8 , Arunangshu Dutta Roy  8 , Mariângela F Silveira  9 , Romina Buffarini  9 , Roger Shapiro  10 , Rebecca Zash  11 , Patrick Kolsteren  12 , Carl Lachat  12 , Lieven Huybregts  12   13 , Dominique Roberfroid  14   15 , Zhonghai Zhu  16 , Lingxia Zeng  16 , Seifu H Gebreyesus  17 , Kokeb Tesfamariam  18 , Seth Adu-Afarwuah  19 , Kathryn G Dewey  20 , Stephaney Gyaase  21 , Kwaku Poku-Asante  21 , Ellen Boamah Kaali  21   22 , Darby Jack  23 , Thulasiraj Ravilla  24 , James Tielsch  25 , Sunita Taneja  26 , Ranadip Chowdhury  26 , Per Ashorn  27 , Kenneth Maleta  28 , Ulla Ashorn  29 , Charles Mangani  28 , Luke C Mullany  1 , Subarna K Khatry  30 , Vundli Ramokolo  31   32 , Wanga Zembe-Mkabile  33   34 , Wafaie W Fawzi  10 , Dongqing Wang  35 , Christentze Schmiegelow  36 , Daniel Minja  37 , Omari Abdul Msemo  37 , John P A Lusingu  37 , Emily R Smith  38 , Honorati Masanja  39 , Aroonsri Mongkolchati  40 , Paniya Keentupthai  41 , Abel Kakuru  42 , Richard Kajubi  42 , Katherine Semrau  43   44   45 , Davidson H Hamer  46   47 , Albert Manasyan  48 , Jake M Pry  49 , Bernard Chasekwa  50 , Jean Humphrey  1 , Robert E Black  1 ; Subnational Collaborative Group for Vulnerable Newborn Mortality; Vulnerable Newborn Measurement Core Group
Collaborators, Affiliations

Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017

Elizabeth A Hazel et al. BJOG. .

Abstract

Objective: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs).

Design: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000.

Setting: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America.

Population: Live birth neonates.

Methods: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies.

Main outcome measures: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification.

Results: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies.

Conclusions: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.

Keywords: low-and middle-income countries, obstetrics and gynaecology; paediatrics: neonatal; preterm; small-for-gestational age.

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References

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