Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

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; CHERG Small-for-Gestational-Age-Preterm Birth Working Group

doi:10.1016/S0140-6736(13)60993-9

Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

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 MongkolchatiLuke 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, CHERG Small-for-Gestational-Age-Preterm Birth Working Group

357 Citations (Scopus)

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.

Original language	English
Journal	Lancet
Volume	382
Issue number	9890
Pages (from-to)	417-25
Number of pages	9
ISSN	0140-6736
DOIs	https://doi.org/10.1016/S0140-6736(13)60993-9
Publication status	Published - 3 Aug 2013

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10.1016/S0140-6736(13)60993-9

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Katz, J., Lee, A. C. C., Kozuki, N., Lawn, J. E., Cousens, S., Blencowe, H., Ezzati, M., Bhutta, Z. A., Marchant, T., Willey, B. A., Adair, L., Barros, F., Baqui, A. H., Christian, P., Fawzi, W., Gonzalez, R., Humphrey, J., Huybregts, L., Kolsteren, P., ... CHERG Small-for-Gestational-Age-Preterm Birth Working Group (2013). Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet, 382(9890), 417-25. https://doi.org/10.1016/S0140-6736(13)60993-9

Katz, J, Lee, ACC, Kozuki, N, Lawn, JE, Cousens, S, Blencowe, H, Ezzati, M, Bhutta, ZA, Marchant, T, Willey, BA, Adair, L, Barros, F, Baqui, AH, Christian, P, Fawzi, W, Gonzalez, R, Humphrey, J, Huybregts, L, Kolsteren, P, Mongkolchati, A, Mullany, LC, Ndyomugyenyi, R, Nien, JK, Osrin, D, Roberfroid, D, Sania, A, Schmiegelow, C, Silveira, MF, Tielsch, J, Vaidya, A, Velaphi, SC, Victora, CG, Watson-Jones, D, Black, RE & CHERG Small-for-Gestational-Age-Preterm Birth Working Group 2013, 'Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis', Lancet, vol. 382, no. 9890, pp. 417-25. https://doi.org/10.1016/S0140-6736(13)60993-9

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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",

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.",

author = "Joanne Katz and Lee, {Anne C C} and Naoko Kozuki and Lawn, {Joy E} and Simon Cousens and Hannah Blencowe and Majid Ezzati and Bhutta, {Zulfiqar A} and Tanya Marchant and Willey, {Barbara A} and Linda Adair and Fernando Barros and Baqui, {Abdullah H} and Parul Christian and Wafaie Fawzi and Rogelio Gonzalez and Jean Humphrey and Lieven Huybregts and Patrick Kolsteren and Aroonsri Mongkolchati and Mullany, {Luke C} and Richard Ndyomugyenyi and Nien, {Jyh Kae} and David Osrin and Dominique Roberfroid and Ayesha Sania and Christentze Schmiegelow and Silveira, {Mariangela F} and James Tielsch and Anjana Vaidya and Velaphi, {Sithembiso C} and Victora, {Cesar G} and Deborah Watson-Jones and Black, {Robert E} and {CHERG Small-for-Gestational-Age-Preterm Birth Working Group}",

year = "2013",

month = aug,

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doi = "10.1016/S0140-6736(13)60993-9",

language = "English",

volume = "382",

pages = "417--25",

journal = "Lancet",

issn = "0140-6736",

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number = "9890",

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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

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 -

Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

Abstract

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