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Session: Improving Nutrition for the First 1,000 Days (Poster Theater Flash Session 5)

(PTFS05-06-23) Birth Anthropometry and Preterm Status Predicts Neonatal and Infant Mortality in Rural Bangladesh

Sunday, July 23, 2023

2:25 PM – 2:29 PM ET

Location: Fairfax

Presenting Author(s)

YK

Yunhee Kang, PhD

Associate Scientist
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States

Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

SS

Saijuddin Shaikh, PhD

Nutritional Epidemiologist
The JiVitA Project, Gaibandha Bangladesh
Gaibandha, Rajshahi, Bangladesh
HA

Hasmot Ali, MBBS, MPH

Senior Research Physician
The JiVitA Project, Gaibandha Bangladesh
Gaibandha, Rajshahi, Bangladesh
LW

Lee S. Wu, MHS

Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
AS

Abu Ahmed Shamim

The JiVitA Project
AL

Alain B. Labrique, PhD

Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
PC

Parul Christian, PhD, MSc

Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Keith P. West, Jr, DrPH

Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States

Disclosure(s):

Yunhee Kang, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: We have previously reported birth anthropometry, using harmonized cutoffs, can optimally predict both neonatal and infant mortality among home-born infants in rural Bangladesh (Kang et al AJCN 2022). This study explores the value of including gestational age at birth (GAb), expressed as preterm vs term birth, to improve primary healthcare worker detection of infants at highest risk of mortality.

Methods: Among 28,026 singletons born in an antenatal micronutrient trial, 20,160 met criteria of being prospectively assessed for GA_b and surviving to be measured within 72 hours, 549 of whom died ≤365 days. Relative risk ratios (RRR) for neonatal and infant mortality were derived for preterm (GA < 37 wks) and term infants and, within each stratum, for infants with one or any pair of measurements below harmonized cutoffs for length (44.5 cm), weight (2200 g), MUAC (9.0 cm), and chest (CC, 28.5 cm) and head (HC, 31 cm) circumference. Term infants with individual or paired measurements below cutoffs served as referents.

Results: Ninety percent of study newborns were born at home and 19.8% were preterm, measured as a mean (SD) of 15 (12) hr after birth. RRRs (95% CI) of neonatal and infant mortality among preterm vs term (referent) were 4.79 (3.85, 5.97) and 3.30 (2.80, 3.89), respectively. RRRs of neonatal and infant mortality among preterm infants with individual measurements below cutoffs ranged from 12.6 to 18.4 and 7.4 to 10.1, and for term infants, 2.5 to 4.7 and 2.2 to 3.7, respectively, with highest RRRs observed for CC < 28.5 cm. All 95% CLs were >1. RRR of neonatal and infant mortality with paired measurements below cutoffs in preterm infants ranged from 16.4 to 22.9 and 10.4 to 12.5, and for term infants, 3.47 to 7.85 and 3.19 to 5.61, respectively, with highest RRRs observed for CC < 28.5 + HC < 31 cm. All 95% CLs were >1.

Conclusions: Relative risk ratios of 8-16 for neonatal death have been reported for home-born infants in Bangladesh surviving when paired measurements are below specified cutoffs. Applying cutoffs to preterm-born infants increases RRRs to 16-23. Applying harmonized cutoffs for any two birth measurements, but especially chest and head circumferences, to infants determined to be born preterm, may allow health workers to identify and most closely follow home-born infants at highest risk of neonatal mortality in rural South Asia.

Funding Sources: Bill & Melinda Gates Foundation