Small vulnerable newborns—big potential for impact

Ashorn, Per; Ashorn, Ulla; Muthiani, Yvonne; Aboubaker, Samira; Askari, Sufia; Bahl, Rajiv; Black, Robert E; Dalmiya, Nita; Duggan, Christopher P; Hofmeyr, G Justus; Kennedy, Stephen H; Klein, Nigel; Lawn, Joy E; Shiffman, Jeremy; Simon, Jonathon; Temmerman, Marleen; Okwaraji, Yemisrach; Krasevec, Julia; Bradley, Ellen; Conkle, Joel; Stevens, Gretchen; Gatica, Giovanna; Ohuma, Eric O.; Coffey, Chris; Estevez Dominguez, Diana; Blencowe, Hannah; Kimathi, Ben; Moller, Ann Beth; Lewin, Alexandra; Hussain-Alkhateeb, Laith; Dalmiya, Nita; Lawn, Joy E.; Borghi, Elaine; Hayashi, Chika

doi:10.1016/s0140-6736(23)00354-9

Cited by 79 publications

(49 citation statements)

References 225 publications

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“…Infants born preterm and/or small-for-gestational age (SGA)-so-called 'small vulnerable newborns [1]'-are at risk of short-and long-term adverse outcomes, including poor growth throughout childhood [1][2][3][4][5]. While most appropriate-for-gestational age (AGA) preterm infants catch up to their term-born peers in weight and height, SGA infants more often remain small throughout childhood [2,3,5].…”

Section: Introductionmentioning

confidence: 99%

One‐year anthropometric follow‐up of South African preterm infants in kangaroo mother care: Which early‐life factors predict malnutrition?

Nel,

Wenhold,

Botha

et al. 2024

Tropical Med Int Health

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BackgroundPreterm infants often have poor short‐ and long‐term growth. Kangaroo mother care supports short‐term growth, but longer‐term outcomes are unclear.MethodsThis study analysed longitudinally collected routine clinical data from a South African cohort of preterm infants (born <37 weeks gestation) attending the outpatient follow‐up clinic of a tertiary‐level hospital (Tshwane District, South Africa) for 1 year between 2012 and 2019. At 1 year, small‐for‐gestational age (SGA) and appropriate‐for‐gestational age (AGA) infants were compared with regard to age‐corrected anthropometric z‐scores (weight‐for‐age [WAZ], length‐for‐age [LAZ], weight‐for‐length [WLZ] and BMI‐for‐age [BMIZ]) and rates of underweight (WAZ < −2), stunting (LAZ < −2), wasting (WLZ < −2) and overweight (BMIZ> + 2). Multiple regression analysis was used to investigate associations between maternal/infant characteristics and rates of underweight, stunting, wasting and overweight.ResultsAt 1 year, compared with AGA infants (n = 210), SGA infants (n = 111) had lower WAZ (−1.26 ± 1.32 vs. −0.22 ± 1.24, p < 0.001), LAZ (−1.50 ± 1.11 vs. −0.60 ± 1.06, p < 0.001), WLZ (−0.66 ± 1.31 vs. 0.11 ± 1.24, p < 0.001) and BMIZ (−0.55 ± 1.31 vs. 1.06 ± 1.23, p < 0.001), despite larger WAZ gains from birth (+0.70 ± 1.30 vs. +0.05 ± 1.30, p < 0.001). SGA infants had significantly more stunting (34.2% vs. 9.1%; p < 0.001), underweight (31.2% vs. 7.2%; p < 0.001) and wasting (12.6% vs. 4.3%, p = 0.012), with no difference in overweight (4.5% vs. 7.7%, p = 0.397). In multiple regression analysis, birth weight‐for‐GA z‐score more consistently predicted 1‐year malnutrition than SGA.ConclusionPreterm‐born SGA infants remain more underweight, stunted and wasted than their preterm‐born AGA peers at 1 year, despite greater WAZ gains. Interventions for appropriate catch‐up growth especially for SGA preterm infants are needed.

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Section: Introductionmentioning

confidence: 99%

One‐year anthropometric follow‐up of South African preterm infants in kangaroo mother care: Which early‐life factors predict malnutrition?

Nel,

Wenhold,

Botha

et al. 2024

Tropical Med Int Health

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“…Neonatal deaths make up a steadily rising proportion of child mortality, currently representing nearly half of the 5 million annual deaths among children aged <5 years 2. The disproportionate burden of neonatal mortality has yielded a heightened focus on identifying vulnerable newborns who can be targeted for interventions to reduce neonatal mortality 3…”

Section: Introductionmentioning

confidence: 99%

Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool

Rees,

Ideh,

Kisenge

et al. 2024

BMJ Open

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IntroductionThe immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify neonates discharged from the neonatal ward at risk for 60-day post-discharge mortality.MethodsWe conducted a prospective observational cohort study of neonates discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania, and John F Kennedy Medical Centre in Monrovia, Liberia. Research staff called caregivers to ascertain vital status up to 60 days after discharge. We conducted multivariable logistic regression analyses with best subset selection to identify socioeconomic, demographic, clinical, and anthropometric factors associated with post-discharge mortality. We used adjusted log coefficients to assign points to each variable and internally validated our tool with bootstrap validation with 500 repetitions.ResultsThere were 2344 neonates discharged and 2310 (98.5%) had post-discharge outcomes available. The median (IQR) age at discharge was 8 (4, 15) days; 1238 (53.6%) were male. In total, 71 (3.1%) died during follow-up (26.8% within 7 days of discharge). Leaving against medical advice (adjusted OR [aOR] 5.62, 95% CI 2.40 to 12.10) and diagnosis of meconium aspiration (aOR 6.98, 95% CI 1.69 to 21.70) conferred the greatest risk for post-discharge mortality. The risk assessment tool included nine variables (total possible score=63) and had an optimism corrected area under the receiver operating characteristic curve of 0.77 (95% CI 0.75 to 0.80). A score of ≥6 was most optimal (sensitivity 68.3% [95% CI 64.8% to 71.5%], specificity 72.1% [95% CI 71.5% to 72.7%]).ConclusionsA small number of factors predicted all-cause, 60-day mortality after discharge from neonatal wards in Tanzania and Liberia. After external validation, this risk assessment tool may facilitate clinical decision making for eligibility for discharge and the direction of resources to follow-up high risk neonates.

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“…Prematurity, defined as delivery before completing the 37 weeks of gestation, represents a global health concern [1]. Besides the significant postnatal morbidity and mortality, preterm-born infants may face lifelong medical challenges, including neuro-developmental, pulmonary, cardiovascular, and metabolic impairment [2,3]. Even though advancements in perinatal care have ameliorated these short-and long-term consequences [1,2], prematurity may still be associated with pulmonary and cardiovascular alterations [4] that deter their daily activities, including tolerance to exercise [2,3].…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Exercise Performance of Children Born Non-Extremely Preterm

Fouzas,

Nourloglou,

Vervenioti

et al. 2024

Children

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Data on exercise tolerance of children born non-extremely preterm are sparse. We aimed to explore the cardiopulmonary exercise testing (CPET) characteristics in this population. We studied 63 children (age 7–12 years) born at 290/7–366/7 weeks of gestation (34 were late preterm, 29 were preterm) and 63 age-matched, term-born controls. All performed spirometry and CPET (cycle ergometry). There were no differences in activity levels and spirometric parameters between the group of preterm-born children and controls. A peak oxygen uptake (VO2peak) of <80% was noted in 25.4% of the term-born and 49.2% of preterm-born children (p = 0.001). Term-born participants presented similar VO2peak to late-preterm children but higher than those born at <340/7 weeks of gestation (p = 0.002). Ventilatory limitation was noted in 4.8% of term and 7.9% of preterm participants, while only one preterm child presented cardiovascular limitation. Children born before 34 weeks of gestation had higher respiratory rates and smaller tidal volumes at maximum exercise, as well as lower oxygen uptake for the level of generated work. We conclude that school-age children born at 29–34 weeks of gestation may present decreased exercise performance attributed to an altered ventilatory response to exercise and impaired O2 utilization by their skeletal muscles rather than other cardiopulmonary limiting factors.

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Small vulnerable newborns—big potential for impact

Cited by 79 publications

References 225 publications

One‐year anthropometric follow‐up of South African preterm infants in kangaroo mother care: Which early‐life factors predict malnutrition?

One‐year anthropometric follow‐up of South African preterm infants in kangaroo mother care: Which early‐life factors predict malnutrition?

Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool

Cardiopulmonary Exercise Performance of Children Born Non-Extremely Preterm

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