Predictors of neonatal mortality

Development and validation of prognostic models using prospective data from rural Bangladesh

Bibliographic Data

ID21880468
AuthorsFarhad Khan (0000-0002-2027-8953, Johns Hopkins University), Luke C Mullany (0000-0003-4668-9803, Johns Hopkins University), Lee F-S Wu (Johns Hopkins University), Hasmot Ali (0000-0003-0044-1992, Johns Hopkins University), Saijuddin Shaikh (0000-0001-5095-1478, Johns Hopkins University), Kelsey Alland (0000-0001-8464-6308, Johns Hopkins University), Keith P West (0000-0001-9458-362X, Johns Hopkins University), Alain Labrique (0000-0003-2502-7819, Johns Hopkins University, corresponding author)
Year2020
Volume5
Issue1
Pagese001983
Publication date2020-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2019-001983
PMID32133171
OpenAlexW3003814360
LanguageEN
Citations received1
References cited41

Objective: To assess the extent to which maternal histories of newborn danger signs independently or combined with birth weight and/or gestational age (GA) can capture and/or predict postsecond day (age>48 hours) neonatal death. Methods: Data from a cluster-randomised trial conducted in rural Bangladesh were split into development and validation sets. The prompted recall of danger signs and birth weight measurements were collected within 48 hours postchildbirth. Maternally recalled danger signs included cyanosis (any part of the infant's body was blue at birth), non-cephalic presentation (part other than head came out first at birth), lethargy (weak or no arm/leg movement and/or cry at birth), trouble suckling (infant unable to suckle/feed normally in the 2 days after birth or before death, collected 1-month postpartum or from verbal autopsy). Last menstrual period was collected at maternal enrolment early in pregnancy. Singleton newborns surviving 2 days past childbirth were eligible for analysis. Prognostic multivariable models were developed and internally validated. Results: Recalling ≥1 sign of lethargy, cyanosis, non-cephalic presentation or trouble suckling identified postsecond day neonatal death with 65.3% sensitivity, 60.8% specificity, 2.1% positive predictive value (PPV) and 99.3% negative predictive value (NPV) in the development set. Requiring either lethargy or weight <2.5 kg identified 89.1% of deaths (at 39.7% specificity, 1.9% PPV and 99.6% NPV) while lethargy or preterm birth (<37 weeks) captured 81.0% of deaths (at 53.6% specificity, 2.3% PPV and 99.5% NPV). A simplified model (birth weight, GA, lethargy, cyanosis, non-cephalic presentation and trouble suckling) predicted death with good discrimination (validation area under the receiver-operator characteristic curve (AUC) 0.80, 95% CI 0.73 to 0.87). A further simplified model (GA, non-cephalic presentation, lethargy, trouble suckling) predicted death with moderate discrimination (validation AUC 0.74, 95% CI 0.66 to 0.81). Conclusion: Maternally recalled danger signs, coupled to either birth weight or GA, can predict and capture postsecond day neonatal death with high discrimination and sensitivity

Environmental health · Infant mortality · Intensive care medicine · Neonatal mortality · Population · Prospective cohort study · Global Maternal and Child Health · Maternal and Neonatal Healthcare · Medicine · Pregnancy and preeclampsia studies · Internal Medicine · Pediatrics

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