Risk Factors for Neonatal Mortality: an Observational Cohort Study in Sarlahi District of Rural Southern Nepal

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Sep 14

PMID 37709319

Authors

Tingting Yan

Luke C Mullany

Seema Subedi

Elizabeth A Hazel

Subarna K Khatry

Diwakar Mohan

Scott Zeger

James M Tielsch

Steven C LeClerq

Joanne Katz

Affiliations

Soon will be listed here.

Abstract

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 <145 cm to 145-150 cm (aHR: 0.78, 95% CI: (0.65 to 0.94)) to ≥150 cm (aHR: 0.57, 95% CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95% CI: (0.53 to 0.86)) and education >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.

Citing Articles

Factors Predicting Completion of Four or More Antenatal Care Visits in Sarlahi District, Nepal.

Yue Y, Hazel E, Subedi S, Zeger S, Mohan D, Mullany L Res Sq. 2024; .

PMID: 38853894 PMC: 11160911. DOI: 10.21203/rs.3.rs-4467441/v1.

Comparison of pregnancy and neonatal outcomes in a retrospective full pregnancy history survey versus population-based prospective records: a validation study in rural Sarlahi District, Nepal.

Erchick D, Lama T, Subedi S, Verhulst A, Guillot M, Khatry S J Health Popul Nutr. 2023; 42(1):139.

PMID: 38066542 PMC: 10709973. DOI: 10.1186/s41043-023-00472-5.

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