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

Authors

Elizabeth A. Hazel, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Daniel J. Erchick, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Joanne Katz, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Anne C. Lee, Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Michael Diaz, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Lee S. Wu, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Keith P. West, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Abu Ahmed Shamim, BRAC JP Grant School of Public Health, Dhaka, Bangladesh.
Parul Christian, Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Hasmot Ali, JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh.
Abdullah H. Baqui, International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Samir K. Saha, Child Health Research Foundation, Dhaka, Bangladesh.
Salahuddin Ahmed, Projahnmo Research Foundation, Dhaka, Bangladesh.
Arunangshu Dutta Roy, Projahnmo Research Foundation, Dhaka, Bangladesh.
Mariângela F. Silveira, Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil.
Romina Buffarini, Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil.
Roger Shapiro, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Rebecca Zash, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Patrick Kolsteren, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Carl Lachat, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Lieven Huybregts, Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.
Dominique Roberfroid, Namur University, Namur, Belgium.
Zhonghai Zhu, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
Lingxia Zeng, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.
Seifu H. Gebreyesus, Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Kokeb Tesfamariam, Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
Seth Adu-Afarwuah, Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
Kathryn G. Dewey, Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA.
Stephaney Gyaase, Kintampo Health Research Centre, Kintampo, Ghana.
Kwaku Poku-Asante, Kintampo Health Research Centre, Kintampo, Ghana.
Ellen Boamah Kaali, Kintampo Health Research Centre, Kintampo, Ghana.
Darby Jack, Columbia University's Mailman School of Public Health, New York, New York, USA.

Document Type

Journal Article

Publication Date

1-16-2024

Journal

BJOG : an international journal of obstetrics and gynaecology

DOI

10.1111/1471-0528.17743

Keywords

low birthweight; newborn; preterm birth

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 , 39 -41 (reference category), 37 -38 , 34 -36 ,34 -36 ,32 -33 , 30 -31 , 28 -29 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 37 -38  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.

Department

Global Health

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