Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020

Lorena Suárez‐Idueta; Hannah Blencowe; Yemisrach B Okwaraji; Judith Yargawa; Ellen Bradley; Adrienne Gordon; Vicki Flenady; Enny S. Paixao; Mauricio L. Barreto; Sarka Lisonkova; Qi Wen; Petr Velebil; Jitka Jírová; Erzsebet Horváth‐Puhó; Henrik Toft Sørensen; Luule Sakkeus; Liili Abuladze; Khalid A. Yunis; Ayah Al Bizri; Arturo Barranco; Lisa Broeders; Aimée E. van Dijk; Fawziya Alyafei; Tawa O. Olukade; Neda Razaz; Jonas Söderling; Lucy K. Smith; Elizabeth S. Draper; Estelle Lowry; Neil Rowland; Rachael Wood; Kirsten Monteath; Isabel Pereyra; Gabriella Pravia; Eric O. Ohuma; Joy E. Lawn; Kara Warrilow; Harriet Lawford; Arturo Barranco Flores; Jesus Felipe Gonzalez Roldan; Mai AlQubaisi; Tawa O. Olukade; Hamdy A. Ali; Bradley N. Manktelow; Ruth J. Matthews; Alan Fenton; Celina Davis; Bob Black; Joanne Katz; Dan Erchick; the National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group

doi:10.1111/1471-0528.17506

Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020

Lorena Suárez‐Idueta, Hannah Blencowe^*, Yemisrach B Okwaraji, Judith Yargawa, Ellen Bradley, Adrienne Gordon, Vicki Flenady, Enny S. Paixao, Mauricio L. Barreto, Sarka Lisonkova, Qi Wen, Petr Velebil, Jitka Jírová, Erzsebet Horváth‐Puhó, Henrik Toft Sørensen, Luule Sakkeus, Liili Abuladze, Khalid A. Yunis, Ayah Al Bizri, Arturo BarrancoLisa Broeders, Aimée E. van Dijk, Fawziya Alyafei, Tawa O. Olukade, Neda Razaz, Jonas Söderling, Lucy K. Smith, Elizabeth S. Draper, Estelle Lowry, Neil Rowland, Rachael Wood, Kirsten Monteath, Isabel Pereyra, Gabriella Pravia, Eric O. Ohuma, Joy E. Lawn, Kara Warrilow, Harriet Lawford, Arturo Barranco Flores, Jesus Felipe Gonzalez Roldan, Mai AlQubaisi, Tawa O. Olukade, Hamdy A. Ali, Bradley N. Manktelow, Ruth J. Matthews, Alan Fenton, Celina Davis, Bob Black, Joanne Katz, Dan Erchick, the National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group

^*Corresponding author for this work

School of Natural and Built Environment

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Abstract

Objective
To compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000–2020.

Design
Population-based, multi-country study.

Setting
National data systems in 15 middle- and high-income countries.

Methods
We used individual-level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size-for-gestational age (small [SGA], 90th centile) according to INTERGROWTH-21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types.

Main outcome measures
Mortality of six newborn types.

Results
Of 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6–73.9), PT + AGA (median 34.3, IQR 23.9–37.5) and PT + LGA (median 28.3, IQR 18.4–32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5–54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2–388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7–342.8) compared with those between 2500 g and 4000 g as a reference group.

Conclusion
Preterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co-existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level.

Original language	English
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Early online date	08 May 2023
DOIs	https://doi.org/10.1111/1471-0528.17506
Publication status	Early online date - 08 May 2023

Keywords

SUPPLEMENT ARTICLE
SUPPLEMENT ARTICLES
neonatal mortality
preterm birth
size for gestational age
vulnerable newborn

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020
Copyright 2023 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 1.86 MBLicence: CC BY

Cite this

Suárez‐Idueta, L., Blencowe, H., Okwaraji, Y. B., Yargawa, J., Bradley, E., Gordon, A., Flenady, V., Paixao, E. S., Barreto, M. L., Lisonkova, S., Wen, Q., Velebil, P., Jírová, J., Horváth‐Puhó, E., Sørensen, H. T., Sakkeus, L., Abuladze, L., Yunis, K. A., Al Bizri, A., ... the National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group (2023). Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020. BJOG: An International Journal of Obstetrics and Gynaecology. Advance online publication. https://doi.org/10.1111/1471-0528.17506

@article{bb6974836e1e4c18a5b10dd813c10a98,

title = "Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020",

abstract = "ObjectiveTo compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000–2020.DesignPopulation-based, multi-country study.SettingNational data systems in 15 middle- and high-income countries.MethodsWe used individual-level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size-for-gestational age (small [SGA], 90th centile) according to INTERGROWTH-21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types.Main outcome measuresMortality of six newborn types.ResultsOf 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6–73.9), PT + AGA (median 34.3, IQR 23.9–37.5) and PT + LGA (median 28.3, IQR 18.4–32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5–54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2–388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7–342.8) compared with those between 2500 g and 4000 g as a reference group.ConclusionPreterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co-existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level.",

keywords = "SUPPLEMENT ARTICLE, SUPPLEMENT ARTICLES, neonatal mortality, preterm birth, size for gestational age, vulnerable newborn",

author = "Lorena Su{\'a}rez‐Idueta and Hannah Blencowe and Okwaraji, {Yemisrach B} and Judith Yargawa and Ellen Bradley and Adrienne Gordon and Vicki Flenady and Paixao, {Enny S.} and Barreto, {Mauricio L.} and Sarka Lisonkova and Qi Wen and Petr Velebil and Jitka J{\'i}rov{\'a} and Erzsebet Horv{\'a}th‐Puh{\'o} and S{\o}rensen, {Henrik Toft} and Luule Sakkeus and Liili Abuladze and Yunis, {Khalid A.} and Ayah Al Bizri and Arturo Barranco and Lisa Broeders and {van Dijk}, {Aim{\'e}e E.} and Fawziya Alyafei and Olukade, {Tawa O.} and Neda Razaz and Jonas S{\"o}derling and Smith, {Lucy K.} and Draper, {Elizabeth S.} and Estelle Lowry and Neil Rowland and Rachael Wood and Kirsten Monteath and Isabel Pereyra and Gabriella Pravia and Ohuma, {Eric O.} and Lawn, {Joy E.} and Kara Warrilow and Harriet Lawford and Flores, {Arturo Barranco} and Roldan, {Jesus Felipe Gonzalez} and Mai AlQubaisi and Olukade, {Tawa O.} and Ali, {Hamdy A.} and Manktelow, {Bradley N.} and Matthews, {Ruth J.} and Alan Fenton and Celina Davis and Bob Black and Joanne Katz and Dan Erchick and {the National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group}",

year = "2023",

month = may,

day = "8",

doi = "10.1111/1471-0528.17506",

language = "English",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "John Wiley & Sons Inc.",

}

Suárez‐Idueta, L, Blencowe, H, Okwaraji, YB, Yargawa, J, Bradley, E, Gordon, A, Flenady, V, Paixao, ES, Barreto, ML, Lisonkova, S, Wen, Q, Velebil, P, Jírová, J, Horváth‐Puhó, E, Sørensen, HT, Sakkeus, L, Abuladze, L, Yunis, KA, Al Bizri, A, Barranco, A, Broeders, L, van Dijk, AE, Alyafei, F, Olukade, TO, Razaz, N, Söderling, J, Smith, LK, Draper, ES, Lowry, E , Rowland, N, Wood, R, Monteath, K, Pereyra, I, Pravia, G, Ohuma, EO, Lawn, JE, Warrilow, K, Lawford, H, Flores, AB, Roldan, JFG, AlQubaisi, M, Olukade, TO, Ali, HA, Manktelow, BN, Matthews, RJ, Fenton, A, Davis, C, Black, B, Katz, J, Erchick, D & the National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group 2023, 'Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020', BJOG: An International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.17506

TY - JOUR

T1 - Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020

AU - Suárez‐Idueta, Lorena

AU - Blencowe, Hannah

AU - Okwaraji, Yemisrach B

AU - Yargawa, Judith

AU - Bradley, Ellen

AU - Gordon, Adrienne

AU - Flenady, Vicki

AU - Paixao, Enny S.

AU - Barreto, Mauricio L.

AU - Lisonkova, Sarka

AU - Wen, Qi

AU - Velebil, Petr

AU - Jírová, Jitka

AU - Horváth‐Puhó, Erzsebet

AU - Sørensen, Henrik Toft

AU - Sakkeus, Luule

AU - Abuladze, Liili

AU - Yunis, Khalid A.

AU - Al Bizri, Ayah

AU - Barranco, Arturo

AU - Broeders, Lisa

AU - van Dijk, Aimée E.

AU - Alyafei, Fawziya

AU - Olukade, Tawa O.

AU - Razaz, Neda

AU - Söderling, Jonas

AU - Smith, Lucy K.

AU - Draper, Elizabeth S.

AU - Lowry, Estelle

AU - Rowland, Neil

AU - Wood, Rachael

AU - Monteath, Kirsten

AU - Pereyra, Isabel

AU - Pravia, Gabriella

AU - Ohuma, Eric O.

AU - Lawn, Joy E.

AU - Warrilow, Kara

AU - Lawford, Harriet

AU - Flores, Arturo Barranco

AU - Roldan, Jesus Felipe Gonzalez

AU - AlQubaisi, Mai

AU - Olukade, Tawa O.

AU - Ali, Hamdy A.

AU - Manktelow, Bradley N.

AU - Matthews, Ruth J.

AU - Fenton, Alan

AU - Davis, Celina

AU - Black, Bob

AU - Katz, Joanne

AU - Erchick, Dan

AU - the National Vulnerable Newborn Mortality Collaborative Group and Vulnerable Newborn Measurement Core Group

PY - 2023/5/8

Y1 - 2023/5/8

N2 - ObjectiveTo compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000–2020.DesignPopulation-based, multi-country study.SettingNational data systems in 15 middle- and high-income countries.MethodsWe used individual-level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size-for-gestational age (small [SGA], 90th centile) according to INTERGROWTH-21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types.Main outcome measuresMortality of six newborn types.ResultsOf 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6–73.9), PT + AGA (median 34.3, IQR 23.9–37.5) and PT + LGA (median 28.3, IQR 18.4–32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5–54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2–388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7–342.8) compared with those between 2500 g and 4000 g as a reference group.ConclusionPreterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co-existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level.

AB - ObjectiveTo compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000–2020.DesignPopulation-based, multi-country study.SettingNational data systems in 15 middle- and high-income countries.MethodsWe used individual-level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size-for-gestational age (small [SGA], 90th centile) according to INTERGROWTH-21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types.Main outcome measuresMortality of six newborn types.ResultsOf 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6–73.9), PT + AGA (median 34.3, IQR 23.9–37.5) and PT + LGA (median 28.3, IQR 18.4–32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5–54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2–388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7–342.8) compared with those between 2500 g and 4000 g as a reference group.ConclusionPreterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co-existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level.

KW - SUPPLEMENT ARTICLE

KW - SUPPLEMENT ARTICLES

KW - neonatal mortality

KW - preterm birth

KW - size for gestational age

KW - vulnerable newborn

U2 - 10.1111/1471-0528.17506

DO - 10.1111/1471-0528.17506

M3 - Article

SN - 1470-0328

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

ER -

Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000–2020

Abstract

Keywords

UN SDGs

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