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
Issued Date
2024-01-01
Resource Type
ISSN
14700328
eISSN
14710528
Scopus ID
2-s2.0-85182491431
Journal Title
BJOG: An International Journal of Obstetrics and Gynaecology
Rights Holder(s)
SCOPUS
Bibliographic Citation
BJOG: An International Journal of Obstetrics and Gynaecology (2024)
Suggested Citation
Hazel E.A., Erchick D.J., Katz J., Lee A.C.C., Diaz M., Wu L.S.F., West K.P., Shamim A.A., Christian P., Ali H., Baqui A.H., Saha S.K., Ahmed S., Roy A.D., Silveira M.F., Buffarini R., Shapiro R., Zash R., Kolsteren P., Lachat C., Huybregts L., Roberfroid D., Zhu Z., Zeng L., Gebreyesus S.H., Tesfamariam K., Adu-Afarwuah S., Dewey K.G., Gyaase S., Poku-Asante K., Boamah Kaali E., Jack D., Ravilla T., Tielsch J., Taneja S., Chowdhury R., Ashorn P., Maleta K., Ashorn U., Mangani C., Mullany L.C., Khatry S.K., Ramokolo V., Zembe-Mkabile W., Fawzi W.W., Wang D., Schmiegelow C., Minja D., Msemo O.A., Lusingu J.P.A., Smith E.R., Masanja H., Mongkolchati A., Keentupthai P., Kakuru A., Kajubi R., Semrau K., Hamer D.H., Manasyan A., Pry J.M., Chasekwa B., Humphrey J., Black R.E. 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. BJOG: An International Journal of Obstetrics and Gynaecology (2024). doi:10.1111/1471-0528.17743 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/95858
Title
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
Author(s)
Hazel E.A.
Erchick D.J.
Katz J.
Lee A.C.C.
Diaz M.
Wu L.S.F.
West K.P.
Shamim A.A.
Christian P.
Ali H.
Baqui A.H.
Saha S.K.
Ahmed S.
Roy A.D.
Silveira M.F.
Buffarini R.
Shapiro R.
Zash R.
Kolsteren P.
Lachat C.
Huybregts L.
Roberfroid D.
Zhu Z.
Zeng L.
Gebreyesus S.H.
Tesfamariam K.
Adu-Afarwuah S.
Dewey K.G.
Gyaase S.
Poku-Asante K.
Boamah Kaali E.
Jack D.
Ravilla T.
Tielsch J.
Taneja S.
Chowdhury R.
Ashorn P.
Maleta K.
Ashorn U.
Mangani C.
Mullany L.C.
Khatry S.K.
Ramokolo V.
Zembe-Mkabile W.
Fawzi W.W.
Wang D.
Schmiegelow C.
Minja D.
Msemo O.A.
Lusingu J.P.A.
Smith E.R.
Masanja H.
Mongkolchati A.
Keentupthai P.
Kakuru A.
Kajubi R.
Semrau K.
Hamer D.H.
Manasyan A.
Pry J.M.
Chasekwa B.
Humphrey J.
Black R.E.
Erchick D.J.
Katz J.
Lee A.C.C.
Diaz M.
Wu L.S.F.
West K.P.
Shamim A.A.
Christian P.
Ali H.
Baqui A.H.
Saha S.K.
Ahmed S.
Roy A.D.
Silveira M.F.
Buffarini R.
Shapiro R.
Zash R.
Kolsteren P.
Lachat C.
Huybregts L.
Roberfroid D.
Zhu Z.
Zeng L.
Gebreyesus S.H.
Tesfamariam K.
Adu-Afarwuah S.
Dewey K.G.
Gyaase S.
Poku-Asante K.
Boamah Kaali E.
Jack D.
Ravilla T.
Tielsch J.
Taneja S.
Chowdhury R.
Ashorn P.
Maleta K.
Ashorn U.
Mangani C.
Mullany L.C.
Khatry S.K.
Ramokolo V.
Zembe-Mkabile W.
Fawzi W.W.
Wang D.
Schmiegelow C.
Minja D.
Msemo O.A.
Lusingu J.P.A.
Smith E.R.
Masanja H.
Mongkolchati A.
Keentupthai P.
Kakuru A.
Kajubi R.
Semrau K.
Hamer D.H.
Manasyan A.
Pry J.M.
Chasekwa B.
Humphrey J.
Black R.E.
Author's Affiliation
Zvitambo Institute for Maternal and Child Health Research
Kamuzu University of Health Sciences
Ariadne Labs
Infectious Diseases Research Collaboration
Belgian Health Care Knowledge Centre
Nepal Nutrition Intervention Project-Sarlahi
Centre for Infectious Disease Research in Zambia
Kintampo Health Research Centre
Ghana Health Service
Ifakara Health Institute
Addis Ababa University
National Institute For Medical Research Tanzania
Society for Applied Studies Kolkata
Universiteit Gent
Harvard T.H. Chan School of Public Health
Milken Institute School of Public Health
Københavns Universitet
Ubon Ratchathani University
Beth Israel Deaconess Medical Center
School of Basic Medical Sciences
South African Medical Research Council
The University of Alabama at Birmingham
School of Public Health
George Mason University
University of Ghana
Brigham and Women's Hospital
Copenhagen University Hospital
Universidade Federal de Pelotas
University of California, Davis
Gertrude H. Sergievsky Center
Mailman School of Public Health
Mahidol University
Tampere University
BRAC University
University Hospital of Tampere
Aravind Eye Hospital
Université de Namur
Boston University Chobanian & Avedisian School of Medicine
Johns Hopkins Bloomberg School of Public Health
Harvard Medical School
University of South Africa
International Food Policy Research Institute
JiVitA Maternal and Child Health Research Project
Projahnmo Research Foundation
Child Health Research Foundation
Kamuzu University of Health Sciences
Ariadne Labs
Infectious Diseases Research Collaboration
Belgian Health Care Knowledge Centre
Nepal Nutrition Intervention Project-Sarlahi
Centre for Infectious Disease Research in Zambia
Kintampo Health Research Centre
Ghana Health Service
Ifakara Health Institute
Addis Ababa University
National Institute For Medical Research Tanzania
Society for Applied Studies Kolkata
Universiteit Gent
Harvard T.H. Chan School of Public Health
Milken Institute School of Public Health
Københavns Universitet
Ubon Ratchathani University
Beth Israel Deaconess Medical Center
School of Basic Medical Sciences
South African Medical Research Council
The University of Alabama at Birmingham
School of Public Health
George Mason University
University of Ghana
Brigham and Women's Hospital
Copenhagen University Hospital
Universidade Federal de Pelotas
University of California, Davis
Gertrude H. Sergievsky Center
Mailman School of Public Health
Mahidol University
Tampere University
BRAC University
University Hospital of Tampere
Aravind Eye Hospital
Université de Namur
Boston University Chobanian & Avedisian School of Medicine
Johns Hopkins Bloomberg School of Public Health
Harvard Medical School
University of South Africa
International Food Policy Research Institute
JiVitA Maternal and Child Health Research Project
Projahnmo Research Foundation
Child Health Research Foundation
Corresponding Author(s)
Other Contributor(s)
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+0, 39+0–41+6 (reference category), 37+0–38+6, 34+0–36+6,34+0–36+6,32+0–33+6, 30+0–31+6, 28+0–29+6 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 370–386 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.