Citation
Lee, Anne C. C.; Kozuki, Naoko; Cousens, Simon N.; Stevens, Gretchen A.; Blencowe, Hannah; Silveira, Mariangela F.; Sania, Ayesha; Rosen, Heather E.; Schmiegelow, Christentze; & Adair, Linda S., et al. (2017). Estimates of Burden and Consequences of Infants Born Small for Gestational Age in Low and Middle Income Countries with INTERGROWTH-21(st) Standard: Analysis of CHERG Datasets. BMJ, 358, j3677. PMCID: PMC5558898Abstract
Objectives: To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21(st) birth weight standard. Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21(st) birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated.Setting: CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results: In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700).
Conclusions: In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countries
URL
http://dx.doi.org/10.1136/bmj.j3677Reference Type
Journal ArticleYear Published
2017Journal Title
BMJAuthor(s)
Lee, Anne C. C.Kozuki, Naoko
Cousens, Simon N.
Stevens, Gretchen A.
Blencowe, Hannah
Silveira, Mariangela F.
Sania, Ayesha
Rosen, Heather E.
Schmiegelow, Christentze
Adair, Linda S.
Baqui, Abdullah H.
Barros, Fernando C.
Bhutta, Zulfiqar A.
Caulfield, Laura E.
Christian, Parul
Clarke, Siân E.
Fawzi, Wafaie W.
Gonzalez, Rogelio
Humphrey, Jean H.
Huybregts, Lieven
Kariuki, Simon
Kolsteren, Patrick
Lusingu, John
Manandhar, Dharma
Mongkolchati, Aroonsri
Mullany, Luke C.
Ndyomugyenyi, Richard
Nien, Jyh Kae
Roberfroid, Dominique
Saville, Naomi M.
Terlouw, Dianne J.
Tielsch, James M.
Victora, Cesar G.
Velaphi, Sithembiso C.
Watson-Jones, Deborah
Willey, Barbara A.
Ezzati, Majid
Lawn, Joy E.
Black, Robert E.
Katz, Joanne