Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study
Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in resource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after accurately determined preterm birth in such settings. This community-based stratif...
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| creator | Gladstone, Melissa White, Sarah Kafulafula, George Neilson, James P van den Broek, Nynke |
| description | Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in resource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after accurately determined preterm birth in such settings.
This community-based stratified cohort study conducted between May-December 2006 in Southern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/placebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based on ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation and 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer, admissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and Malawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio 1.79, 95% CI 1.09-2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; p |
| doi_str_mv | 10.1371/journal.pmed.1001121 |
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This community-based stratified cohort study conducted between May-December 2006 in Southern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/placebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based on ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation and 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer, admissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and Malawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio 1.79, 95% CI 1.09-2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; p<0.001) or wasted (weight-for-length z score; p<0.01) with no effect of gestational age at delivery. Preterm infants more often screened positively for disability on the Ten Question Questionnaire (p = 0.002). They also had higher rates of developmental delay on the MDAT at 18 months (p = 0.009), with gestational age at delivery (p = 0.01) increasing this likelihood. Morbidity-visits to a health centre (93%) and admissions to hospital (22%)-was similar for both groups.
During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a disadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal period, a refocus on early childhood is needed to improve outcomes for infants born preterm in low-income settings.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1001121</identifier><identifier>PMID: 22087079</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Antibiotics ; Babies ; Child Development ; Cohort Studies ; Complications and side effects ; Diseases ; Female ; Gestational Age ; Humans ; Infant Mortality ; Infant, Newborn ; Infant, Premature - physiology ; Infants ; Infants (Newborn) ; Low income groups ; Malawi - epidemiology ; Medicine ; Morbidity ; Mortality ; Patient outcomes ; Pregnancy ; Pregnancy Complications ; Premature birth ; Premature Birth - mortality ; Questionnaires ; Studies ; Ultrasonic imaging</subject><ispartof>PLoS medicine, 2011-11, Vol.8 (11), p.e1001121-e1001121</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Gladstone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Gladstone M, White S, Kafulafula G, Neilson JP, van den Broek N (2011) Post-neonatal Mortality, Morbidity, and Developmental Outcome after Ultrasound-Dated Preterm Birth in Rural Malawi: A Community-Based Cohort Study. PLoS Med 8(11): e1001121. doi:10.1371/journal.pmed.1001121</rights><rights>Gladstone et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c829t-68fbf6d62a5794930cdfafcf95c63d7bad6c53dda3b3a0230eed518870936d0e3</citedby><cites>FETCH-LOGICAL-c829t-68fbf6d62a5794930cdfafcf95c63d7bad6c53dda3b3a0230eed518870936d0e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210771/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210771/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,2098,2917,23853,27911,27912,53778,53780,79355,79356</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22087079$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Smith, Gordon C.</contributor><creatorcontrib>Gladstone, Melissa</creatorcontrib><creatorcontrib>White, Sarah</creatorcontrib><creatorcontrib>Kafulafula, George</creatorcontrib><creatorcontrib>Neilson, James P</creatorcontrib><creatorcontrib>van den Broek, Nynke</creatorcontrib><title>Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in resource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after accurately determined preterm birth in such settings.
This community-based stratified cohort study conducted between May-December 2006 in Southern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/placebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based on ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation and 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer, admissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and Malawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio 1.79, 95% CI 1.09-2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; p<0.001) or wasted (weight-for-length z score; p<0.01) with no effect of gestational age at delivery. Preterm infants more often screened positively for disability on the Ten Question Questionnaire (p = 0.002). They also had higher rates of developmental delay on the MDAT at 18 months (p = 0.009), with gestational age at delivery (p = 0.01) increasing this likelihood. Morbidity-visits to a health centre (93%) and admissions to hospital (22%)-was similar for both groups.
During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a disadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal period, a refocus on early childhood is needed to improve outcomes for infants born preterm in low-income settings.</description><subject>Age</subject><subject>Antibiotics</subject><subject>Babies</subject><subject>Child Development</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Diseases</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant Mortality</subject><subject>Infant, Newborn</subject><subject>Infant, Premature - physiology</subject><subject>Infants</subject><subject>Infants (Newborn)</subject><subject>Low income groups</subject><subject>Malawi - epidemiology</subject><subject>Medicine</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Pregnancy</subject><subject>Pregnancy Complications</subject><subject>Premature birth</subject><subject>Premature Birth - mortality</subject><subject>Questionnaires</subject><subject>Studies</subject><subject>Ultrasonic imaging</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk9uO0zAQhiMEYpeFN0AQCQmERIodN3bMBdJqxaHSwiJOt9bEdlpXiV1sZ6GvwRPjbrOrFvUClAuPJt__jz2jybKHGE0wYfjl0g3eQjdZ9VpNMEIYl_hWdoyrKS8wZfT2TnyU3QthiVDJEUd3s6OyRDVDjB9nvz-5EAurnYUIXd47nw4T1y82YWPUVQhW5Upf6s6lYnbDuSFK1-sc2qh9PnTRQ3CDVYWCqFW-8jrl-7wxPi5yY3M_-KT6AB38NK9yyJO4H2wyLxoISSDdIlXOQxzU-n52p4Uu6AfjeZJ9e_vm69n74vzi3ezs9LyQdcljQeu2aamiJVSMTzlBUrXQypZXkhLFGlBUVkQpIA0BVBKktapwnd7NCVVIk5Ps8dZ31bkgxnYGgcu6RrxEFCVitiWUg6VYedODXwsHRlwlnJ8L8NHITgtJaTmlSkmm1RTXDDhpatRgxZAE3rTJ6_VYbWjSxGTqY2rJnun-H2sWYu4uBSkxYgwng2ejgXc_Bh2i6E2QuusgTW8IgqOKsgojksgnf5GHHzdSc0j3N7Z1qazceIrTkk0JYrSuE1UcoOba6nRHZ3VrUnqPnxzg06d0b-RBwfM9QWKi_hXnMIQgZl8-_wf78d_Zi-_77NMddqGhi4vguiEaZ8M-ON2C0rsQvG5v5oeR2GzldafFZivFuJVJ9mh39jei6zUkfwDbqjSl</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Gladstone, Melissa</creator><creator>White, Sarah</creator><creator>Kafulafula, George</creator><creator>Neilson, James P</creator><creator>van den Broek, Nynke</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope></search><sort><creationdate>20111101</creationdate><title>Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study</title><author>Gladstone, Melissa ; White, Sarah ; Kafulafula, George ; Neilson, James P ; van den Broek, Nynke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c829t-68fbf6d62a5794930cdfafcf95c63d7bad6c53dda3b3a0230eed518870936d0e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Age</topic><topic>Antibiotics</topic><topic>Babies</topic><topic>Child Development</topic><topic>Cohort Studies</topic><topic>Complications and side effects</topic><topic>Diseases</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant Mortality</topic><topic>Infant, Newborn</topic><topic>Infant, Premature - physiology</topic><topic>Infants</topic><topic>Infants (Newborn)</topic><topic>Low income groups</topic><topic>Malawi - epidemiology</topic><topic>Medicine</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Patient outcomes</topic><topic>Pregnancy</topic><topic>Pregnancy Complications</topic><topic>Premature birth</topic><topic>Premature Birth - mortality</topic><topic>Questionnaires</topic><topic>Studies</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gladstone, Melissa</creatorcontrib><creatorcontrib>White, Sarah</creatorcontrib><creatorcontrib>Kafulafula, George</creatorcontrib><creatorcontrib>Neilson, James P</creatorcontrib><creatorcontrib>van den Broek, Nynke</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gladstone, Melissa</au><au>White, Sarah</au><au>Kafulafula, George</au><au>Neilson, James P</au><au>van den Broek, Nynke</au><au>Smith, Gordon C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>8</volume><issue>11</issue><spage>e1001121</spage><epage>e1001121</epage><pages>e1001121-e1001121</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Preterm birth is considered to be associated with an estimated 27% of neonatal deaths, the majority in resource-poor countries where rates of prematurity are high. There is no information on medium term outcomes after accurately determined preterm birth in such settings.
This community-based stratified cohort study conducted between May-December 2006 in Southern Malawi followed up 840 post-neonatal infants born to mothers who had received antenatal antibiotic prophylaxis/placebo in an attempt to reduce rates of preterm birth (APPLe trial ISRCTN84023116). Gestational age at delivery was based on ultrasound measurement of fetal bi-parietal diameter in early-mid pregnancy. 247 infants born before 37 wk gestation and 593 term infants were assessed at 12, 18, or 24 months. We assessed survival (death), morbidity (reported by carer, admissions, out-patient attendance), growth (weight and height), and development (Ten Question Questionnaire [TQQ] and Malawi Developmental Assessment Tool [MDAT]). Preterm infants were at significantly greater risk of death (hazard ratio 1.79, 95% CI 1.09-2.95). Surviving preterm infants were more likely to be underweight (weight-for-age z score; p<0.001) or wasted (weight-for-length z score; p<0.01) with no effect of gestational age at delivery. Preterm infants more often screened positively for disability on the Ten Question Questionnaire (p = 0.002). They also had higher rates of developmental delay on the MDAT at 18 months (p = 0.009), with gestational age at delivery (p = 0.01) increasing this likelihood. Morbidity-visits to a health centre (93%) and admissions to hospital (22%)-was similar for both groups.
During the first 2 years of life, infants who are born preterm in resource poor countries, continue to be at a disadvantage in terms of mortality, growth, and development. In addition to interventions in the immediate neonatal period, a refocus on early childhood is needed to improve outcomes for infants born preterm in low-income settings.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22087079</pmid><doi>10.1371/journal.pmed.1001121</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Age Antibiotics Babies Child Development Cohort Studies Complications and side effects Diseases Female Gestational Age Humans Infant Mortality Infant, Newborn Infant, Premature - physiology Infants Infants (Newborn) Low income groups Malawi - epidemiology Medicine Morbidity Mortality Patient outcomes Pregnancy Pregnancy Complications Premature birth Premature Birth - mortality Questionnaires Studies Ultrasonic imaging |
| title | Post-neonatal mortality, morbidity, and developmental outcome after ultrasound-dated preterm birth in rural Malawi: a community-based cohort study |
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