TY - JOUR
T1 - Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries
T2 - a pooled country analysis
AU - Katz, Joanne
AU - Lee, Anne C C
AU - Kozuki, Naoko
AU - Lawn, Joy E
AU - Cousens, Simon
AU - Blencowe, Hannah
AU - Ezzati, Majid
AU - Bhutta, Zulfiqar A
AU - Marchant, Tanya
AU - Willey, Barbara A
AU - Adair, Linda
AU - Barros, Fernando
AU - Baqui, Abdullah H
AU - Christian, Parul
AU - Fawzi, Wafaie
AU - Gonzalez, Rogelio
AU - Humphrey, Jean
AU - Huybregts, Lieven
AU - Kolsteren, Patrick
AU - Mongkolchati, Aroonsri
AU - Mullany, Luke C
AU - Ndyomugyenyi, Richard
AU - Nien, Jyh Kae
AU - Osrin, David
AU - Roberfroid, Dominique
AU - Sania, Ayesha
AU - Schmiegelow, Christentze
AU - Silveira, Mariangela F
AU - Tielsch, James
AU - Vaidya, Anjana
AU - Velaphi, Sithembiso C
AU - Victora, Cesar G
AU - Watson-Jones, Deborah
AU - Black, Robert E
AU - CHERG Small-for-Gestational-Age-Preterm Birth Working Group
N1 - Copyright © 2013 Elsevier Ltd. All rights reserved.
PY - 2013/8/3
Y1 - 2013/8/3
N2 - 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.
AB - 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.
U2 - 10.1016/S0140-6736(13)60993-9
DO - 10.1016/S0140-6736(13)60993-9
M3 - Journal article
C2 - 23746775
SN - 0140-6736
VL - 382
SP - 417
EP - 425
JO - Lancet
JF - Lancet
IS - 9890
ER -
