Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21^ststandard: analysis of CHERG datasets

Abstract

Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st 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-21st 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

Gestational Age and Pregnancy Outcomes

“…Preterm birth can further be subdivided on the basis of gestational age: extremely preterm (<28 weeks), very preterm (28-32 weeks), and moderate or late preterm [32][33][34][35][36][37] completed weeks of gestation. Since decreasing gestational age is associated with increasing mortality, disability, and cost due to intensity of neonatal care, these subdivisions are important [7].…”

“…While in the United States and other affluent countries, severe growth restriction is not common, the consequence of it not being recognized may include severe morbidity and in some cases even perinatal death [34]. According to the Child Health Epidemiology Reference Group (CHERG) dataset which uses INTERGROWTH21st standard, in 2012, an estimated 23.3 million or 19.3% infants were born small for gestational age in low-and middle-income countries [35]. Among these, 11.2 million were term and not LBW, 10.7 million were term and LBW, and 1.5 million were preterm.…”

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

“…15 Moreover, the incidence of BPD was reported to increase up to 50% in very low birth weight infants, and the burden of SGA in low-and middle-income countries was reported to be quite high. 16,17 However, few studies have investigated the relationship between SGA and BPD through pulmonary function indices.…”

Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries

“…Poor nutritional status of neonates is a major cause of illness and can lead to poor growth, increased risk of infection, bleeding and neonatal death [3][4][5]. The risk of morbidity and mortality during the neonatal period is higher in lowand middle-income countries where many births happen at home and the prevalence of maternal malnutrition and incidence of low birth weight (birth weight less than 2500 g) and preterm birth (gestational age < 37 weeks) is high [3, 6,7]. The most important nutritional intervention at birth is breastfeeding [4].…”