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.
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 238 143 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.8, interquartile range [IQR] 2.0–3.2), 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.
Authors
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; Smith, Emily R; Masanja, Honorati; Mongkolchati, Aroonsri; Keentupthai, Paniya; Kakuru, Abel; Kajubi, Richard; Semrau, Katherine; Hamer, Davidson H; Manasyan, Albert; Pry, Jake M; Chasekwa, Bernard; Humphrey, Jean; Black, Robert E
Citation
Hazel, Elizabeth A.; Erchick, Daniel J.; Katz, Joanne; Lee, Anne C. C.; Huybregts, Lieven; et al. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 143 live births in low- and middle-income settings from 2000 to 2017. BJOG: An International Journal of Obstetrics and Gynaecology. Article in press. First published online January 16, 2024. https://doi.org/10.1111/1471-0528.17743
Keywords
Southern Africa; Eastern Africa; Latin America; Low Birthweight; Newborn; Preterm Birth; Vulnerability; Obstetrics; Mortality; Low Income Groups
Access/Licence
Limited Access
Record type
Journal Article
