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Title: Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: A pooled country analysis
Authors: Joanne Katz
Anne C.C. Lee
Naoko Kozuki
Joy E. Lawn
Simon Cousens
Hannah Blencowe
Majid Ezzati
Zulfiqar A. Bhutta
Tanya Marchant
Barbara A. Willey
Linda Adair
Fernando Barros
Abdullah H. Baqui
Parul Christian
Wafaie Fawzi
Rogelio Gonzalez
Jean Humphrey
Lieven Huybregts
Patrick Kolsteren
Aroonsri Mongkolchati
Luke C. Mullany
Richard Ndyomugyenyi
Jyh Kae Nien
David Osrin
Dominique Roberfroid
Ayesha Sania
Christentze Schmiegelow
Mariangela F. Silveira
James Tielsch
Anjana Vaidya
Sithembiso C. Velaphi
Cesar G. Victora
Deborah Watson-Jones
Robert E. Black
Johns Hopkins Bloomberg School of Public Health
Brigham and Women's Hospital
Save the Children USA
London School of Hygiene & Tropical Medicine
Imperial College London
The Aga Khan University
The University of North Carolina System
Universidade Federal de Pelotas
Harvard School of Public Health
Pontificia Universidad Catolica de Chile
Clinica Santa Maria
Universiteit Gent
Prins Leopold Instituut voor Tropische Geneeskunde
Mahidol University
Uganda Ministry of Health
Clinica Davila
Universidad de los Andes, Santiago
UCL Institute of Child Health
George Washington University
Kobenhavns Universitet
Copenhagen University Hospital
University of Witwatersrand
National Institutes of Medical Research
Keywords: Medicine
Issue Date: 7-Jun-2013
Citation: The Lancet. Vol.382, No.9890 (2013), 417-425
Abstract: Background Babies with low birthweight (<2500 g) are at increased risk of early mortality. However, low birthweight includes babies born preterm and with fetal growth restriction, and not all these infants have a birthweight less than 2500 g. We estimated the neonatal and infant mortality associated with these two characteristics in low-income and middle-income countries. Methods For this pooled analysis, we searched all available studies and identified 20 cohorts (providing data for 2015019 livebirths) from Asia, Africa, and Latin America that recorded data for birthweight, gestational age, and vital statistics through 28 days of life. Study dates ranged from 1982 through to 2010. We calculated relative risks (RR) and risk differences (RD) for mortality associated with preterm birth (<32 weeks, 32 weeks to <34 weeks, 34 weeks to <37 weeks), small-for-gestational-age (SGA; babies with birthweight in the lowest third percentile and between the third and tenth percentile of a US reference population), and preterm and SGA combinations. Findings Pooled overall RRs for preterm were 6·82 (95% CI 3·56-13·07) for neonatal mortality and 2·50 (1·48-4·22) for post-neonatal mortality. Pooled RRs for babies who were SGA (with birthweight in the lowest tenth percentile of the reference population) were 1·83 (95% CI 1·34-2·50) for neonatal mortality and 1·90 (1·32-2·73) for post-neonatal mortality. The neonatal mortality risk of babies who were both preterm and SGA was higher than that of babies with either characteristic alone (15·42; 9·11-26·12). Interpretation Many babies in low-income and middle-income countries are SGA. Preterm birth affects a smaller number of neonates than does SGA, but is associated with a higher mortality risk. The mortality risks associated with both characteristics extend beyond the neonatal period. Differentiation of the burden and risk of babies born preterm and SGA rather than with low birthweight could guide prevention and management strategies to speed progress towards Millennium Development Goal 4 - the reduction of child mortality. © 2013 Elsevier Ltd.
ISSN: 1474547X
Appears in Collections:Scopus 2011-2015

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