Paixao Enny S, Blencowe Hannah, Falcao Ila Rocha, Ohuma Eric O, Rocha Aline Dos Santos, Alves Flávia Jôse Oliveira, Costa Maria da Conceição N, Suárez-Idueta Lorena, Ortelan Naiá, Smeeth Liam, Rodrigues Laura C, Lawn Joy E, de Almeida Marcia Furquim, Ichihara Maria Yury, Silva Rita de Cássia Ribeiro, Teixeira Maria Gloria, Barreto Mauricio L
Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
Lancet Reg Health Am. 2021 Nov;3:None. doi: 10.1016/j.lana.2021.100045.
Preterm birth (<37 weeks), low birth weight (LBW,<2500g), and small for gestational age (SGA,<10th centile of birth weight for gestational age and sex) are markers of newborn vulnerability with a high risk of mortality. We estimated the prevalence of phenotypes combining these three markers and quantified the mortality risk associated with them.
Population-based cohort study using routine register-based linked data on all births and deaths in Brazil from January 1, 2011, to December 31, 2018. We estimated the prevalence of preterm, LBW, and SGA individually and for phenotypes combining these characteristics. The mortality risk associated with each phenotype: early neonatal, late neonatal, neonatal, post-neonatal, infant, 1-4 years, and under five years was quantified using mortality rates and hazard ratios (HRs) with 95% confidence interval (CI) were estimated using Cox proportional hazard models.
17,646,115 live births were included. Prevalence of preterm birth, LBW and SGA were 9.4%, 9.6% and 9.2%, respectively. Neonatal mortality risk was 16-fold (HR=15.9; 95% CI:15.7-16.1) higher for preterm compared to term, 3 times higher (HR=3.4; (95% CI:3.3-3.4) for SGA compared to adequate for gestational age (AGA), and >25 times higher for LBW (HR=25.8; (95% CI:25.5-26.1) compared to normal birth weight (NBW). 18% of all live births were included in one of the small vulnerable newborn phenotypes. Of those 8.2% were term-SGA (4.7%NBW, 3.5%LBW), 0.6% were term-AGA-LBW, 8.3% preterm-AGA (3.8%NBW, 4.5%LBW) and 1.0% preterm-SGA-LBW. Compared to term-AGA-NBW, the highest mortality risk was for preterm-LBW phenotypes (HR=36.2(95%CI 35.6-36.8) preterm-AGA-LBW, HR=62.0(95%CI 60.8-63.2) preterm-SGA-LBW). The increased mortality risk associated with vulnerable newborn phenotypes was highest in the first month of life, with attenuated but continued high risk in the post-neonatal period and 1-4 years of age.
Our findings support the value of using more detailed phenotypes to identify those at highest risk. More granular data can inform care at the individual level, advance research, especially for prevention, and accelerate progress towards global targets such as the Sustainable Development Goals.
Wellcome Trust.
早产（<37周）、低出生体重（LBW，<2500g）和小于胎龄儿（SGA，出生体重低于同孕周和性别的第10百分位数）是新生儿脆弱性的标志，死亡风险很高。我们估计了合并这三种标志的表型的患病率，并量化了与之相关的死亡风险。
基于人群的队列研究，使用2011年1月1日至2018年12月31日巴西所有出生和死亡的基于常规登记的关联数据。我们分别估计了早产、低出生体重和小于胎龄儿以及合并这些特征的表型的患病率。使用死亡率和风险比（HRs）量化与每种表型相关的死亡风险：早期新生儿、晚期新生儿、新生儿、新生儿后期、婴儿、1-4岁和5岁以下，并使用Cox比例风险模型估计95%置信区间（CI）。
纳入17,646,115例活产。早产、低出生体重和小于胎龄儿的患病率分别为9.4%、9.6%和9.2%。与足月儿相比，早产儿的新生儿死亡风险高16倍（HR=15.9；95%CI：15.7-16.1），与适于胎龄儿（AGA）相比，小于胎龄儿的死亡风险高3倍（HR=3.4；（95%CI：3.3-3.4），与正常出生体重（NBW）相比，低出生体重儿的死亡风险高>25倍（HR=25.8；（95%CI：25.5-26.1）。所有活产中有18%被纳入脆弱新生儿小表型之一。其中8.2%为足月儿-SGA（4.7%NBW，3.5%LBW），0.6%为足月儿-AGA-LBW，8.3%为早产儿-AGA（3.8%NBW，4.5%LBW），1.0%为早产儿-SGA-LBW。与足月儿-AGA-NBW相比，早产-LBW表型的死亡风险最高（HR=36.2（95%CI 35.6-36.8）早产-AGA-LBW，HR=62.0（95%CI 60.8-63.2）早产-SGA-LBW）。与脆弱新生儿表型相关的死亡风险增加在生命的第一个月最高，在新生儿后期和1-4岁时风险减弱但持续较高。
我们的研究结果支持使用更详细的表型来识别风险最高的人群的价值。更细化的数据可为个体水平的护理提供信息，推动研究进展，尤其是预防方面的研究，并加速实现可持续发展目标等全球目标的进程。
惠康信托基金会。
