1. Infants born both premature and small-for-gestational age are at a higher risk for mortality
2. Data suggests that the highest relative risk for low-birth weight infants is in Latin America
Evidence Rating Level: 3 (fair)
Study Rundown: Low-birth weight infants are at a heightened risk for developing disease and having poor outcomes leading to mortality. Among other causes, low-birth weight can be associated with premature birth as well as small-for-gestational age size. This study looks at birth cohorts in low and middle income countries to determine how mortality risk is associated with different degrees of prematurity and fetal size.
Based on 20 different datasets that aggregate over two million lives from around the world, overall mortality risk associated with preterm low-birth weight was higher than risks associated with small-for-gestational age size of infant. However, babies born both preterm and small-for-gestational age were between 10.05 and 39.48 times more at risk for mortality in the first 28 days. The highest overall mortality rates were recorded in African and Asian countries, however the highest relative risk for low-birth weight was found in Latin America. Researchers recommend public health interventions to target preterm and small for gestational age infants to reduce mortality in lower to middle income countries.
In Depth [Review]: The largest cohort included in this research came from the Chilean national birth registry (n=1,901,611) followed by a cohort from Nepal (n=23,662) and Zimbabwe (n=14,110). The highest percentage of low-birth weight babies was identified in Nepal (39%), the highest percentage of prematurity was in Pakistan (28%), and the highest percentage of small-for-gestational age was found in India (62%).
Infants born both preterm and small-for-gestational age had an RR of 15.97 for early neonatal mortality, whereas infants born preterm but appropriate size had an RR of 9.06 and infants born at term but small-for-gestational age had an RR of 3.12. Small-for-gestational age is often associated with adolescent pregnancy, maternal malnutrition, and low maternal height. Researchers admitted the difficulty of aligning measurements and reducing variability across multiple datasets recorded in different countries by different research groups and governments. However, this study identifies strategies to reduce child mortality and progress toward Millennium Development Goal 4.
By Jordan Anderson and Andrew Bishara
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