TY - JOUR
T1 - Neonatal mortality risk of vulnerable newborns
T2 - A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017
AU - Subnational Collaborative Group for Vulnerable Newborn Mortality
AU - Vulnerable Newborn Measurement Core Group
AU - Hazel, Elizabeth A.
AU - Erchick, Daniel J.
AU - Katz, Joanne
AU - Lee, Anne C.C.
AU - Diaz, Michael
AU - Wu, Lee S.F.
AU - West, Keith P.
AU - Shamim, Abu Ahmed
AU - Christian, Parul
AU - Ali, Hasmot
AU - Baqui, Abdullah H.
AU - Saha, Samir K.
AU - Ahmed, Salahuddin
AU - Roy, Arunangshu Dutta
AU - Silveira, Mariângela F.
AU - Buffarini, Romina
AU - Shapiro, Roger
AU - Zash, Rebecca
AU - Kolsteren, Patrick
AU - Lachat, Carl
AU - Huybregts, Lieven
AU - Roberfroid, Dominique
AU - Zhu, Zhonghai
AU - Zeng, Lingxia
AU - Gebreyesus, Seifu H.
AU - Tesfamariam, Kokeb
AU - Adu-Afarwuah, Seth
AU - Dewey, Kathryn G.
AU - Gyaase, Stephaney
AU - Poku-Asante, Kwaku
AU - Boamah Kaali, Ellen
AU - Jack, Darby
AU - Ravilla, Thulasiraj
AU - Tielsch, James
AU - Taneja, Sunita
AU - Chowdhury, Ranadip
AU - Ashorn, Per
AU - Maleta, Kenneth
AU - Ashorn, Ulla
AU - Mangani, Charles
AU - Mullany, Luke C.
AU - Khatry, Subarna K.
AU - Ramokolo, Vundli
AU - Zembe-Mkabile, Wanga
AU - Fawzi, Wafaie W.
AU - Wang, Dongqing
AU - Schmiegelow, Christentze
AU - Minja, Daniel
AU - Msemo, Omari Abdul
AU - Lusingu, John P.A.
N1 - Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2025/11
Y1 - 2025/11
N2 - 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 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0–2.9), 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.
AB - 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 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0–2.9), 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.
KW - low-and middle-income countries, obstetrics and gynaecology
KW - paediatrics: neonatal
KW - preterm
KW - small-for-gestational age
UR - https://www.scopus.com/pages/publications/105024018781
U2 - 10.1111/1471-0528.17518
DO - 10.1111/1471-0528.17518
M3 - Article
C2 - 37156238
AN - SCOPUS:105024018781
SN - 1470-0328
VL - 132
SP - S48-S59
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - S8
ER -
