Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Med. 2012;9(8):e1001292. doi: 10.1371/journal.pmed.1001292. Epub 2012 Aug 14.
Low birth weight and prematurity are amongst the strongest predictors of neonatal death. However, the extent to which they act independently is poorly understood. Our objective was to estimate the neonatal mortality risk associated with preterm birth when stratified by weight for gestational age in the high mortality setting of East Africa.
Members and collaborators of the Malaria and the MARCH Centers, at the London School of Hygiene & Tropical Medicine, were contacted and protocols reviewed for East African studies that measured (1) birth weight, (2) gestational age at birth using antenatal ultrasound or neonatal assessment, and (3) neonatal mortality. Ten datasets were identified and four met the inclusion criteria. The four datasets (from Uganda, Kenya, and two from Tanzania) contained 5,727 births recorded between 1999-2010. 4,843 births had complete outcome data and were included in an individual participant level meta-analysis. 99% of 445 low birth weight (< 2,500 g) babies were either preterm (< 37 weeks gestation) or small for gestational age (below tenth percentile of weight for gestational age). 52% of 87 neonatal deaths occurred in preterm or small for gestational age babies. Babies born < 34 weeks gestation had the highest odds of death compared to term babies (odds ratio [OR] 58.7 [95% CI 28.4-121.4]), with little difference when stratified by weight for gestational age. Babies born 34-36 weeks gestation with appropriate weight for gestational age had just three times the likelihood of neonatal death compared to babies born term, (OR 3.2 [95% CI 1.0-10.7]), but the likelihood for babies born 34-36 weeks who were also small for gestational age was 20 times higher (OR 19.8 [95% CI 8.3-47.4]). Only 1% of babies were born moderately premature and small for gestational age, but this group suffered 8% of deaths. Individual level data on newborns are scarce in East Africa; potential biases arising due to the non-systematic selection of the individual studies, or due to the methods applied for estimating gestational age, are discussed.
Moderately preterm babies who are also small for gestational age experience a considerably increased likelihood of neonatal death in East Africa.
低出生体重和早产是新生儿死亡的最强预测因素之一。然而，它们在多大程度上独立作用尚不清楚。我们的目的是在东非高死亡率环境中，按胎龄体重分层，估计与早产相关的新生儿死亡风险。
伦敦卫生与热带医学院疟疾和母婴健康研究中心的成员和合作者被联系，并对在东非进行的研究进行了方案审查，这些研究测量了（1）出生体重，（2）产前超声或新生儿评估确定的出生时胎龄，和（3）新生儿死亡率。确定了 10 个数据集，其中 4 个符合纳入标准。这 4 个数据集（来自乌干达、肯尼亚和坦桑尼亚的两个地方）包含了 1999-2010 年间记录的 5727 例分娩。4843 例分娩有完整的结局数据，并纳入了个体参与者水平的荟萃分析。445 例低出生体重（<2500g）婴儿中，有 99%为早产儿（<37 周妊娠）或小于胎龄儿（体重低于胎龄的第十个百分位数）。87 例新生儿死亡中有 52%发生在早产儿或小于胎龄儿中。与足月儿相比，出生于<34 周妊娠的婴儿死亡的可能性最高（比值比 [OR] 58.7 [95% CI 28.4-121.4]），而按胎龄体重分层时差异较小。出生于 34-36 周妊娠且胎龄体重适宜的婴儿与足月儿相比，其新生儿死亡的可能性仅增加了 3 倍（OR 3.2 [95% CI 1.0-10.7]），但出生于 34-36 周且体重小于胎龄儿的可能性增加了 20 倍（OR 19.8 [95% CI 8.3-47.4]）。只有 1%的婴儿为中度早产儿且小于胎龄儿，但该组死亡比例为 8%。东非新生儿个体水平数据稀缺；由于个别研究的非系统性选择，或由于估计胎龄的方法，可能存在偏差，对此进行了讨论。
在东非，中度早产儿且体重小于胎龄儿的新生儿死亡可能性显著增加。
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