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Preterm birth and neonatal mortality in a rural Bangladeshi cohort: implications for health programs
A H Baqui1, H E Rosen, A C C Lee
11] Department of International Health, International Center for Maternal and Newborn Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA [2] Center for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
Insights
Preterm birth impacts nearly 20% of newborns, contributing significantly to neonatal mortality. Management strategies focusing on moderate and late preterm infants are crucial for reducing deaths in community settings.
Area of Science:
- Neonatal Health
- Public Health
- Maternal-Fetal Medicine
Background:
- Prematurity is a leading cause of neonatal mortality globally.
- Understanding gestational age-specific risks is vital for targeted interventions.
- Community-based data collection offers insights into real-world birth outcomes.
Purpose of the Study:
- To quantify the burden of preterm birth.
- To determine gestational age-specific neonatal mortality rates.
- To inform public health programs with actionable recommendations.
Main Methods:
- Prospective community-based study involving 10,585 mother-newborn pairs.
- Data collection by trained community health workers on pregnancy, childbirth, and newborn outcomes.
- Analysis of gestational age and neonatal mortality rates.
Main Results:
- 19.4% of infants were born preterm, with late preterm (34-36 weeks) being the largest subgroup.
- Preterm infants accounted for 46% of all neonatal deaths.
- Gestational age-specific analyses revealed significant mortality contributions from very, moderate, and late preterm births.
Conclusions:
- Moderate and late preterm infants represent a critical target group for intervention.
- Home-based or first-level facility management may be effective in settings with limited referral capacity.
- Public health strategies should consider tailored approaches for different preterm subgroups.
Objective:
To estimate the burden of prematurity, determine gestational age (GA)-specific neonatal mortality rates and provide recommendations for country programs.
Study Design:
Prospective data on pregnancy, childbirth, GA and newborn mortality collected by trained community health workers from 10 585 mother-newborn pairs in a community-based study.
Result:
A total of 19.4% of newborn infants were preterm; 13.5% were late preterm (born between 34 and 36 weeks of gestation), 3.3% were moderate preterm (born at 32 to 33 weeks) and 2.6% were extremely preterm (born at 28 to 31 weeks of gestation). Preterm babies experienced 46% of all neonatal deaths; 40% of preterm deaths were in late preterm, 20% in moderate preterm and 40% in very preterm infants. The population attributable fraction of neonatal mortality in premature babies was 0.16 for very preterm, 0.07 for moderately preterm and 0.10 for late preterm.
Conclusion:
In settings where the majority of births and newborn deaths occur at home and successful referral is a challenge, moderate and late preterm babies may be an important target group for home-based or first-level facility-based management.
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