Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal
| Autor: | Joanne Katz, James M Tielsch, Scott Zeger, Luke C Mullany, Diwakar Mohan, Subarna K Khatry, Steven C LeClerq, Tingting Yan, Seema Subedi, Elizabeth A Hazel |
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| Jazyk: | angličtina |
| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | BMJ Open, Vol 13, Iss 9 (2023) |
| Druh dokumentu: | article |
| ISSN: | 2022-0669 2044-6055 |
| DOI: | 10.1136/bmjopen-2022-066931 |
| Popis: | Objectives To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal.Design This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal.Setting Rural Sarlahi district, Nepal.Participants 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017.Main outcome The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality.Results There were 32 004 live births and 998 neonatal deaths. SGA and/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95% CI: (4.44 to 11.31)), SGA and term/post-term (aHR: 2.12, 95% CI: (1.58 to 2.86)), appropriate-for-gestational-age/large-for-gestational-age and preterm (aHR: 3.23, 95% CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95% CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95% CI: (4.25 to 7.48)), births at health posts/clinics or in hospital (aHR: 1.34, 95% CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95% CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from 5 years (aHR: 0.75, 95% CI: (0.62 to 0.92)).Conclusion SGA and/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested.Trial registration number NCT01177111. |
| Databáze: | Directory of Open Access Journals |
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