Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017

Elizabeth A Hazel; Daniel J Erchick; Joanne Katz; Anne C C Lee; Michael Diaz; Lee S F Wu; Keith P West; Abu Ahmed Shamim; Parul Christian; Hasmot Ali; Abdullah H Baqui; Samir K Saha; Salahuddin Ahmed; Arunangshu Dutta Roy; Mariângela F Silveira; Romina Buffarini; Roger Shapiro; Rebecca Zash; Patrick Kolsteren; Carl Lachat; Lieven Huybregts; Dominique Roberfroid; Zhonghai Zhu; Lingxia Zeng; Seifu H Gebreyesus; Kokeb Tesfamariam; Seth Adu-Afarwuah; Kathryn G Dewey; Stephaney Gyaase; Kwaku Poku-Asante; Ellen Boamah Kaali; Darby Jack; Thulasiraj Ravilla; James Tielsch; Sunita Taneja; Ranadip Chowdhury; Per Ashorn; Kenneth Maleta; Ulla Ashorn; Charles Mangani; Luke C Mullany; Subarna K Khatry; Vundli Ramokolo; Wanga Zembe-Mkabile; Wafaie W Fawzi; Dongqing Wang; Christentze Schmiegelow; Daniel Minja; Omari Abdul Msemo; John P A Lusingu; Subnational Collaborative Group for Vulnerable Newborn Mortality

doi:10.1111/1471-0528.17518

Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017

Elizabeth A Hazel, Daniel J Erchick, Joanne Katz, Anne C C Lee, Michael Diaz, Lee S F Wu, Keith P West, Abu Ahmed Shamim, Parul Christian, Hasmot Ali, Abdullah H Baqui, Samir K Saha, Salahuddin Ahmed, Arunangshu Dutta Roy, Mariângela F Silveira, Romina Buffarini, Roger Shapiro, Rebecca Zash, Patrick Kolsteren, Carl LachatLieven Huybregts, Dominique Roberfroid, Zhonghai Zhu, Lingxia Zeng, Seifu H Gebreyesus, Kokeb Tesfamariam, Seth Adu-Afarwuah, Kathryn G Dewey, Stephaney Gyaase, Kwaku Poku-Asante, Ellen Boamah Kaali, Darby Jack, Thulasiraj Ravilla, James Tielsch, Sunita Taneja, Ranadip Chowdhury, Per Ashorn, Kenneth Maleta, Ulla Ashorn, Charles Mangani, Luke C Mullany, Subarna K Khatry, Vundli Ramokolo, Wanga Zembe-Mkabile, Wafaie W Fawzi, Dongqing Wang, Christentze Schmiegelow, Daniel Minja, Omari Abdul Msemo, John P A Lusingu, Subnational Collaborative Group for Vulnerable Newborn Mortality

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

OBJECTIVE: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs).

DESIGN: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000.

SETTING: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America.

POPULATION: Live birth neonates.

METHODS: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies.

MAIN OUTCOME MEASURES: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification.

RESULTS: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies.

CONCLUSIONS: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.

Original language	English
Journal	BJOG : an international journal of obstetrics and gynaecology
Volume	132
Issue number	Suppl. 8
Pages (from-to)	S48-S59
ISSN	0140-7686
DOIs	https://doi.org/10.1111/1471-0528.17518
Publication status	Published - 2025

Bibliographical note

Keywords

Humans
Infant, Newborn
Infant Mortality/trends
Female
Developing Countries/statistics & numerical data
Infant, Small for Gestational Age
Infant, Low Birth Weight
Infant, Premature
Live Birth/epidemiology
Infant
Male
Birth Weight
Pregnancy
Vulnerable Populations/statistics & numerical data
Risk Factors
Africa South of the Sahara/epidemiology
Premature Birth/mortality
Latin America/epidemiology
Asia/epidemiology

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Hazel, E. A., Erchick, D. J., Katz, J., Lee, A. C. C., Diaz, M., Wu, L. S. F., West, K. P., Shamim, A. A., Christian, P., Ali, H., Baqui, A. H., Saha, S. K., Ahmed, S., Roy, A. D., Silveira, M. F., Buffarini, R., Shapiro, R., Zash, R., Kolsteren, P., ... Subnational Collaborative Group for Vulnerable Newborn Mortality (2025). Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG : an international journal of obstetrics and gynaecology, 132 (Suppl. 8), S48-S59. https://doi.org/10.1111/1471-0528.17518

Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. / Hazel, Elizabeth A; Erchick, Daniel J; Katz, Joanne et al.
In: BJOG : an international journal of obstetrics and gynaecology, Vol. 132 , No. Suppl. 8, 2025, p. S48-S59.

Research output: Contribution to journal › Journal article › Research › peer-review

Hazel, EA, Erchick, DJ, Katz, J, Lee, ACC, Diaz, M, Wu, LSF, West, KP, Shamim, AA, Christian, P, Ali, H, Baqui, AH, Saha, SK, Ahmed, S, Roy, AD, Silveira, MF, Buffarini, R, Shapiro, R, Zash, R, Kolsteren, P, Lachat, C, Huybregts, L, Roberfroid, D, Zhu, Z, Zeng, L, Gebreyesus, SH, Tesfamariam, K, Adu-Afarwuah, S, Dewey, KG, Gyaase, S, Poku-Asante, K, Boamah Kaali, E, Jack, D, Ravilla, T, Tielsch, J, Taneja, S, Chowdhury, R, Ashorn, P, Maleta, K, Ashorn, U, Mangani, C, Mullany, LC, Khatry, SK, Ramokolo, V, Zembe-Mkabile, W, Fawzi, WW, Wang, D, Schmiegelow, C, Minja, D, Msemo, OA, Lusingu, JPA & Subnational Collaborative Group for Vulnerable Newborn Mortality 2025, 'Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017', BJOG : an international journal of obstetrics and gynaecology, vol. 132 , no. Suppl. 8, pp. S48-S59. https://doi.org/10.1111/1471-0528.17518

Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF et al. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG : an international journal of obstetrics and gynaecology. 2025;132 (Suppl. 8):S48-S59. doi: 10.1111/1471-0528.17518

Hazel, Elizabeth A ; Erchick, Daniel J ; Katz, Joanne et al. / Neonatal mortality risk of vulnerable newborns : A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. In: BJOG : an international journal of obstetrics and gynaecology. 2025 ; Vol. 132 , No. Suppl. 8. pp. S48-S59.

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abstract = "OBJECTIVE: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs).DESIGN: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000.SETTING: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America.POPULATION: Live birth neonates.METHODS: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies.MAIN OUTCOME MEASURES: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification.RESULTS: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies.CONCLUSIONS: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.",

keywords = "Humans, Infant, Newborn, Infant Mortality/trends, Female, Developing Countries/statistics & numerical data, Infant, Small for Gestational Age, Infant, Low Birth Weight, Infant, Premature, Live Birth/epidemiology, Infant, Male, Birth Weight, Pregnancy, Vulnerable Populations/statistics & numerical data, Risk Factors, Africa South of the Sahara/epidemiology, Premature Birth/mortality, Latin America/epidemiology, Asia/epidemiology",

author = "Hazel, {Elizabeth A} and Erchick, {Daniel J} and Joanne Katz and Lee, {Anne C C} and Michael Diaz and Wu, {Lee S F} and West, {Keith P} and Shamim, {Abu Ahmed} and Parul Christian and Hasmot Ali and Baqui, {Abdullah H} and Saha, {Samir K} and Salahuddin Ahmed and Roy, {Arunangshu Dutta} and Silveira, {Mari{\^a}ngela F} and Romina Buffarini and Roger Shapiro and Rebecca Zash and Patrick Kolsteren and Carl Lachat and Lieven Huybregts and Dominique Roberfroid and Zhonghai Zhu and Lingxia Zeng and Gebreyesus, {Seifu H} and Kokeb Tesfamariam and Seth Adu-Afarwuah and Dewey, {Kathryn G} and Stephaney Gyaase and Kwaku Poku-Asante and {Boamah Kaali}, Ellen and Darby Jack and Thulasiraj Ravilla and James Tielsch and Sunita Taneja and Ranadip Chowdhury and Per Ashorn and Kenneth Maleta and Ulla Ashorn and Charles Mangani and Mullany, {Luke C} and Khatry, {Subarna K} and Vundli Ramokolo and Wanga Zembe-Mkabile and Fawzi, {Wafaie W} and Dongqing Wang and Christentze Schmiegelow and Daniel Minja and Msemo, {Omari Abdul} and Lusingu, {John P A} and {Subnational Collaborative Group for Vulnerable Newborn Mortality}",

note = "{\textcopyright} 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.",

year = "2025",

doi = "10.1111/1471-0528.17518",

language = "English",

volume = "132 ",

pages = "S48--S59",

journal = "BJOG : an international journal of obstetrics and gynaecology",

issn = "0140-7686",

publisher = "Wiley-Blackwell",

number = "Suppl. 8",

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TY - JOUR

T1 - Neonatal mortality risk of vulnerable newborns

T2 - A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017

AU - Hazel, Elizabeth A

AU - Erchick, Daniel J

AU - Katz, Joanne

AU - Lee, Anne C C

AU - Diaz, Michael

AU - Wu, Lee S F

AU - West, Keith P

AU - Shamim, Abu Ahmed

AU - Christian, Parul

AU - Ali, Hasmot

AU - Baqui, Abdullah H

AU - Saha, Samir K

AU - Ahmed, Salahuddin

AU - Roy, Arunangshu Dutta

AU - Silveira, Mariângela F

AU - Buffarini, Romina

AU - Shapiro, Roger

AU - Zash, Rebecca

AU - Kolsteren, Patrick

AU - Lachat, Carl

AU - Huybregts, Lieven

AU - Roberfroid, Dominique

AU - Zhu, Zhonghai

AU - Zeng, Lingxia

AU - Gebreyesus, Seifu H

AU - Tesfamariam, Kokeb

AU - Adu-Afarwuah, Seth

AU - Dewey, Kathryn G

AU - Gyaase, Stephaney

AU - Poku-Asante, Kwaku

AU - Boamah Kaali, Ellen

AU - Jack, Darby

AU - Ravilla, Thulasiraj

AU - Tielsch, James

AU - Taneja, Sunita

AU - Chowdhury, Ranadip

AU - Ashorn, Per

AU - Maleta, Kenneth

AU - Ashorn, Ulla

AU - Mangani, Charles

AU - Mullany, Luke C

AU - Khatry, Subarna K

AU - Ramokolo, Vundli

AU - Zembe-Mkabile, Wanga

AU - Fawzi, Wafaie W

AU - Wang, Dongqing

AU - Schmiegelow, Christentze

AU - Minja, Daniel

AU - Msemo, Omari Abdul

AU - Lusingu, John P A

AU - Subnational Collaborative Group for Vulnerable Newborn Mortality

PY - 2025

Y1 - 2025

N2 - OBJECTIVE: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs).DESIGN: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000.SETTING: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America.POPULATION: Live birth neonates.METHODS: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies.MAIN OUTCOME MEASURES: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification.RESULTS: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies.CONCLUSIONS: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.

AB - OBJECTIVE: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs).DESIGN: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000.SETTING: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America.POPULATION: Live birth neonates.METHODS: We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies.MAIN OUTCOME MEASURES: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification.RESULTS: There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies.CONCLUSIONS: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.

KW - Humans

KW - Infant, Newborn

KW - Infant Mortality/trends

KW - Female

KW - Developing Countries/statistics & numerical data

KW - Infant, Small for Gestational Age

KW - Infant, Low Birth Weight

KW - Infant, Premature

KW - Live Birth/epidemiology

KW - Infant

KW - Male

KW - Birth Weight

KW - Pregnancy

KW - Vulnerable Populations/statistics & numerical data

KW - Risk Factors

KW - Africa South of the Sahara/epidemiology

KW - Premature Birth/mortality

KW - Latin America/epidemiology

KW - Asia/epidemiology

U2 - 10.1111/1471-0528.17518

DO - 10.1111/1471-0528.17518

M3 - Journal article

C2 - 37156238

SN - 0140-7686

VL - 132

SP - S48-S59

JO - BJOG : an international journal of obstetrics and gynaecology

JF - BJOG : an international journal of obstetrics and gynaecology

IS - Suppl. 8

ER -