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

(2013) LANCET. 382(9890). p.417-425
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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 2 015 019 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.
Keywords
PREGNANCY, RANDOMIZED CONTROLLED-TRIAL, DOUBLE-BLIND, NEONATAL-MORTALITY, FETAL-GROWTH, PLACEBO-CONTROLLED TRIAL, VITAMIN-A SUPPLEMENTATION, INTRAUTERINE GROWTH-RETARDATION, MULTIPLE MICRONUTRIENT SUPPLEMENTATION, BRAZIL BIRTH COHORT

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Chicago
Katz, Joanne, Anne CC Lee, Naoko Kozuki, Joy E Lawn, Simon Cousens, Hannah Blencowe, Majid Ezzati, et al. 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): 417–425.
APA
Katz, J., Lee, A. C., Kozuki, N., Lawn, J. E., Cousens, S., Blencowe, H., Ezzati, M., et al. (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), 417–425.
Vancouver
1.
Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. LANCET. 2013;382(9890):417–25.
MLA
Katz, Joanne, Anne CC Lee, Naoko Kozuki, et al. “Mortality Risk in Preterm and Small-for-gestational-age Infants in Low-income and Middle-income Countries: a Pooled Country Analysis.” LANCET 382.9890 (2013): 417–425. Print.
@article{4082127,
  abstract     = {Background: Babies with low birthweight ({\textlangle}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 2 015 019 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 ({\textlangle}32 weeks, 32 weeks to {\textlangle}34 weeks, 34 weeks to {\textlangle}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       = {Katz, Joanne and Lee, Anne CC and Kozuki, Naoko and Lawn, Joy E and Cousens, Simon and Blencowe, Hannah and Ezzati, Majid and Bhutta, Zulfiqar A and Marchant, Tanya and Willey, Barbara and Adair, Linda and Barros, Fernando and Baqui, Abdullah and Christian, Parul and Fawzi, Wafaie and Gonzalez, Rogelio and Humphrey, Jean and Huybregts, Lieven and Kolsteren, Patrick and Mongkolchati, Aroonsri and Mullany, Luke and Ndyomugyenyi, Richard and Nien, Jyh Kae and Osrin, David and Roberfroid, Dominique  and Sania, Ayesha and Schmiegelow, Christentze and Silveira, Mariangela and Tielsch, James and Vaidya, Anjana and Velaphi, Sithembisco and Victora, Cesar and Watson-Jones, Deborah and Black, Robert},
  issn         = {0140-6736},
  journal      = {LANCET},
  language     = {eng},
  number       = {9890},
  pages        = {417--425},
  title        = {Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis},
  url          = {http://dx.doi.org/10.1016/S0140-6736(13)60993-9},
  volume       = {382},
  year         = {2013},
}

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