Mortality and risk factors of small vulnerable newborns in 32 low- and middle-income countries.

IF 8.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

BMC Medicine Pub Date : 2025-10-14 DOI:10.1186/s12916-025-04406-2

Yizhao Huang, Hongling Zhang, Zhaoying Xiong, Yiqing Lv, Zhenxian Jia, Hongxiu Liu, Wei Xia, Shunqing Xu, Tian Chen, Yuanyuan Li

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引用次数: 0

Abstract

Background: In 2022, 2.3 million neonatal deaths occurred globally, the majority of which were in low- and middle-income countries (LMICs). Preterm birth, small for gestational age (SGA), and low birth weight (LBW) are leading causes of neonatal mortality. The Small Vulnerable Newborn (SVN) framework was introduced to unify preterm birth, SGA, and LBW under a single concept. SVNs face significant mortality risks and are predominantly found in LMICs. Understanding the prevalence, mortality risks, and associated factors of SVNs is essential for targeted intervention efforts.

Methods: This study analyzed nationally representative survey data from the Demographic and Health Surveys (DHSs) conducted between 2008 and 2022 in 32 LMICs, covering 197,405 weighted live births among mothers aged 15-49 years. SVN prevalence, neonatal mortality, infant mortality, and associated risk factors were examined using modified Poisson regression and multinomial logistic regression. Population attributable fractions (PAFs) estimated the contribution of modifiable factors.

Results: The overall SVN prevalence was 23.91% across 32 LMICs. Preterm-SGA showed the highest mortality risks compared to term-nonSGA newborns (neonatal: adjusted RR = 17.51 [95% CI, 12.95-23.67]; infant: adjusted RR = 11.86 [95% CI, 9.20-15.29]). Preterm-nonSGA contributed most to overall mortality (neonatal PAF: 11.72%; infant PAF: 8.15%). Risk patterns varied by subtypes: first parity was primary for preterm-nonSGA (PAF: 14.25%), poverty for term-SGA (PAF: 7.95%), while both insufficient antenatal care (< 4 visits) and first parity were major contributors for preterm-SGA (PAF: 22.68% and 20.41%). Adolescent pregnancy showed the strongest association with overall SVNs (adjusted RR = 1.37 [95% CI, 1.33-1.40]).

Conclusions: SVNs remain a significant public health challenge in LMICs, with distinct risk patterns among subtypes suggesting the importance of targeted interventions focusing on antenatal care, socioeconomic factors and adolescent pregnancy prevention.

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32个低收入和中等收入国家中弱小新生儿的死亡率和危险因素。

背景：2022年，全球有230万新生儿死亡，其中大多数发生在低收入和中等收入国家。早产、小胎龄（SGA）和低出生体重（LBW）是新生儿死亡的主要原因。引入了小易危新生儿（SVN）框架，将早产、SGA和LBW统一在一个概念下。svn面临严重的死亡风险，主要发生在中低收入国家。了解svn的患病率、死亡风险和相关因素对于有针对性的干预工作至关重要。方法：本研究分析了2008年至2022年在32个中低收入国家进行的人口与健康调查（dhs）的全国代表性调查数据，涵盖15-49岁母亲的197,405加权活产。采用修正泊松回归和多项逻辑回归对SVN患病率、新生儿死亡率、婴儿死亡率和相关危险因素进行了检查。人口归因分数（Population attribution fractions, PAFs）估计了可改变因子的贡献。结果：32个中低收入国家SVN患病率为23.91%。与足月非sga新生儿相比，早产sga新生儿的死亡率风险最高（新生儿校正RR = 17.51 [95% CI, 12.95-23.67]；婴儿校正RR = 11.86 [95% CI, 9.20-15.29]）。早产儿非sga对总死亡率贡献最大（新生儿PAF: 11.72%；婴儿PAF: 8.15%）。风险模式因亚型而异：非sga早产儿（PAF: 14.25%）的主要风险为首次产次，足月sga早产儿（PAF: 7.95%）的主要风险为贫困，而产前护理不足(结论：svn在中低收入国家仍然是一个重大的公共卫生挑战，亚型之间存在不同的风险模式，这表明有针对性的干预措施的重要性，重点是产前护理、社会经济因素和青少年怀孕预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Medicine 医学-医学：内科

CiteScore

13.10

自引率

1.10%

发文量

435

审稿时长

4-8 weeks

期刊介绍： BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.