Hazel Elizabeth A, Erchick Daniel J, Katz Joanne, Lee Anne C C, Diaz Michael, Wu Lee S F, West Keith P, Shamim Abu Ahmed, Christian Parul, Ali Hasmot, Baqui Abdullah H, Saha Samir K, Ahmed Salahuddin, Roy Arunangshu Dutta, Silveira Mariângela F, Buffarini Romina, Shapiro Roger, Zash Rebecca, Kolsteren Patrick, Lachat Carl, Huybregts Lieven, Roberfroid Dominique, Zhu Zhonghai, Zeng Lingxia, Gebreyesus Seifu H, Tesfamariam Kokeb, Adu-Afarwuah Seth, Dewey Kathryn G, Gyaase Stephaney, Poku-Asante Kwaku, Boamah Kaali Ellen, Jack Darby, Ravilla Thulasiraj, Tielsch James, Taneja Sunita, Chowdhury Ranadip, Ashorn Per, Maleta Kenneth, Ashorn Ulla, Mangani Charles, Mullany Luke C, Khatry Subarna K, Ramokolo Vundli, Zembe-Mkabile Wanga, Fawzi Wafaie W, Wang Dongqing, Schmiegelow Christentze, Minja Daniel, Msemo Omari Abdul, Lusingu John P A, Smith Emily R, Masanja Honorati, Mongkolchati Aroonsri, Keentupthai Paniya, Kakuru Abel, Kajubi Richard, Semrau Katherine, Hamer Davidson H, Manasyan Albert, Pry Jake M, Chasekwa Bernard, Humphrey Jean, Black Robert E
International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BJOG. 2024 Jan 16. doi: 10.1111/1471-0528.17743.
To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017.
Descriptive multi-country secondary data analysis.
Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America.
Liveborn infants from 15 population-based cohorts.
Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42 , 39 -41 (reference category), 37 -38 , 34 -36 ,34 -36 ,32 -33 , 30 -31 , 28 -29 and less than 28 weeks.
Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births).
We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 37 -38 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality.
In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
描述2000年至2017年期间9个低收入和中等收入国家（LMICs）230679例活产中按胎龄和出生体重细分层的死亡风险。
描述性多国二次数据分析。
撒哈拉以南非洲、南亚和东亚以及拉丁美洲的9个低收入和中等收入国家。
来自15个基于人群队列的活产婴儿。
邀请具有高质量出生结局数据的基于人群的次国家级研究加入脆弱新生儿测量协作项目。所有研究均包括出生体重、通过超声或末次月经测量的胎龄、婴儿性别和新生儿存活情况。我们将适宜出生体重定义为2500 - 3999克（参照类别），巨大儿定义为≥4000克，中度低体重定义为1500 - 2499克，极低出生体重定义为<1500克。我们分析了早产、足月和过期产的细分层分类：≥42周、39 - 41周（参照类别）、37 - 38周、34 - 36周、32 - 33周、30 - 31周、28 - 29周以及小于28周。
各研究的新生儿死亡率（NMR）和相对风险（RR）的中位数及四分位间距。我们还按区域研究背景（撒哈拉以南非洲和南亚）和研究水平的NMR（每1000例活产中≤25例与>25例新生儿死亡）对细分类别进行了95%置信区间（CI）的相对死亡风险的荟萃分析。
我们发现胎龄和出生体重越低，新生儿死亡风险越高，二者呈剂量反应关系。最高的NMR和RR出现在孕周<28周的早产婴儿中（每1000例活产中NMR中位数为359.2；RR为18.0，95%CI为8.6 - 37.6）以及极低出生体重儿中（每1000例活产中为462.8；RR为43.4，95%CI为29.5 - 63.9）。我们发现巨大儿无统计学显著的新生儿死亡风险（RR为1.1，95%CI为0.6 - 3.0），但所有早产婴儿、过期产婴儿（RR为1.3，95%CI为1.1 - 1.5）以及孕周为37 - 38周出生的婴儿（RR为1.2，95%CI为1.0 - 1.4）有统计学显著风险。按区域或潜在新生儿死亡率无统计学显著差异。
除了追踪脆弱新生儿类型外，监测更细分的出生体重和胎龄类别将有助于更好地了解脆弱新生儿的预测因素、干预措施和健康结局。必须准确记录所有活产和死产新生儿的体重和胎龄，以追踪孕产妇和新生儿健康状况，并优化对脆弱新生儿的预防和护理。
