Neonatal Death in Low- to Middle-Income Countries: A Global Network Study

Abstract

Objective To determine population-based neonatal mortality rates in low- and middle-income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths.

Methods A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age.

Results Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery.

Conclusion In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth. With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented.

Keywords

neonatal mortality - low-income countries - preterm birth

• References

• 1 Lawn JE, Cousens S, Zupan J. Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why?. Lancet 2005; 365: 891-900
• 2 UNICEF. State of the World's Children 2011. New York: UNICEF; 2011
• 3 Darmstadt GL, Lee AC, Cousens S , et al. 60 million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?. Int J Gynaecol Obstet 2009; 107 (Suppl. 01) S89-S112
• 4 Alexander GR, Kogan M, Bader D, Carlo W, Allen M, Mor J. US birth weight/gestational age-specific neonatal mortality: 1995–1997 rates for whites, Hispanics, and blacks. Pediatrics 2003; 111: e61-e66
• 5 Were FN, Bwibo NO. The contribution of very low birth weight deaths to infant mortality. East Afr Med J 2009; 86: 374-377
• 6 Black RE, Cousens S, Johnson HL , et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010; 375: 1969-1987
• 7 Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. GAPPS Review Group. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth 2010; 10 (Suppl. 01) S1
• 8 Goldenberg RL, McClure EM, Belizán JM. Commentary: reducing the world's stillbirths. BMC Pregnancy Childbirth 2009; 9 (Suppl. 01) S1-S9
• 9 Carlo WA, Goudar SS, Jehan I , et al; First Breath Study Group. Newborn-care training and perinatal mortality in developing countries. N Engl J Med 2010; 362: 614-623
• 10 Carlo WA, Goudar SS, Jehan I , et al; First Breath Study Group. High mortality rates for very low birth weight infants in developing countries despite training. Pediatrics 2010; 126: e1072-e1080
• 11 McClure EM, Wright LL, Goldenberg RL , et al; NICHD FIRST BREATH Study Group. The global network: a prospective study of stillbirths in developing countries. Am J Obstet Gynecol 2007; 197: 247 , e1–e5
• 12 Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Lancet Neonatal Survival Steering Team. Evidence-based, cost-effective interventions: how many newborn babies can we save?. Lancet 2005; 365: 977-988
• 13 Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. Bellagio Child Survival Study Group. How many child deaths can we prevent this year?. Lancet 2003; 362: 65-71
• 14 Koblinsky M, Matthews Z, Hussein J , et al; Lancet Maternal Survival Series steering group. Going to scale with professional skilled care. Lancet 2006; 368: 1377-1386
• 15 Wall SN, Lee AC, Carlo W , et al. Reducing intrapartum-related neonatal deaths in low- and middle-income countries-what works?. Semin Perinatol 2010; 34: 395-407