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

Elizabeth A. Hazel, Daniel J. Erchick, Joanne Katz, Anne C.C. Lee, Michael Diaz, Lee S.F. Wu, Keith P. West, Abu Ahmed Shamim, Parul Christian, Hasmot Ali, Abdullah H. Baqui, Samir K. Saha, Salahuddin Ahmed, Arunangshu Dutta Roy, Mariângela F. Silveira, Romina Buffarini, Roger Shapiro, Rebecca Zash, Patrick Kolsteren, Carl LachatLieven Huybregts, Dominique Roberfroid, Zhonghai Zhu, Lingxia Zeng, Seifu H. Gebreyesus, Kokeb Tesfamariam, Seth Adu-Afarwuah, Kathryn G. Dewey, Stephaney Gyaase, Kwaku Poku-Asante, Ellen Boamah Kaali, Darby Jack, Thulasiraj Ravilla, James Tielsch, Sunita Taneja, Ranadip Chowdhury, Per Ashorn, Kenneth Maleta, Ulla Ashorn, Charles Mangani, Luke C. Mullany, Subarna K. Khatry, Vundli Ramokolo, Wanga Zembe-Mkabile, Wafaie W. Fawzi, Dongqing Wang, Christentze Schmiegelow, Daniel Minja, Omari Abdul Msemo, John P.A. Lusingu, Emily R. Smith, Honorati Masanja, Aroonsri Mongkolchati, Paniya Keentupthai, Abel Kakuru, Richard Kajubi, Katherine Semrau, Davidson H. Hamer, Albert Manasyan, Jake M. Pry, Bernard Chasekwa, Jean Humphrey, Robert E. Black, Rolf D.W. Klemm, Allan B. Massie, Maithilee Mitra, Sucheta Mehra, Kerry J. Schulze, Alfred Sommer, Md Barkat Ullah, Alain B. Labrique, Mabhubur Rashid, Saijuddin Shaikh, Nazma Begum, Nabidul Haque Chowdhury, Md Shafiqul Islam, Rasheda Khanam, Dipak Kumar Mitra, Abdul Quaiyum, Modiegi Diseko, Joseph Makhema, Yue Cheng, Meselech Roro, Bilal Shikur Endris, Charles D. Arnold, Rajiv Bahl, Nita Bhandari, Jose Martines, Sarmila Mazumder, Lotta Hallamaa, Juha Pyykkö, Willy Urassa, Phillippe Deloron, Ib Christian Bygbjerg, Sofie Lykke Moeller, Thor Grundtvig Theander, Alfa Muhihi, Ramadhani Abdallah Noor, Moses R. Kamya, Miriam Nakalembe, Godfrey Biemba, Julie M. Herlihy, Reuben K. Mbewe, Fern Mweena, Kojo Yeboah-Antwi, Andrew Prendergast, Joy E. Lawn, Hannah Blencowe, Eric Ohuma, Yemi Okwaraji, Judith Yargawa, Ellen Bradley, Lorena Suarez Idueta

Research output: Contribution to journalArticlepeer-review

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 238 143 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.

Original languageEnglish (US)
JournalBJOG: An International Journal of Obstetrics and Gynaecology
DOIs
StateAccepted/In press - 2023

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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