title: Neonatal mortality risks among preterm births in a rural Bangladeshi cohort.
abstract: BACKGROUND
  Preterm birth leads to an estimated 35% of neonatal deaths worldwide. Our study analyses neonatal mortality risks among preterm births in rural Bangladesh.
  
  
  METHODS
  Trained community health workers (CHW) prospectively collected data between June 2007 and September 2009.
  
  
  RESULTS
  Among 32 126 livebirths, 22.3% were preterm (delivered at <37 weeks gestation) and almost half (46.4%) of all neonatal deaths occurred among preterm babies. Preterm babies who were born as the first child {[risk ratio (RR) 1.4; 95% confidence interval (CI) 1.1, 1.8]} and in the poorest households [RR 1.7; 95% CI 1.2, 2.4] were at higher mortality risk. Birth and newborn care preparedness was associated with lower risk of mortality [RR 0.3; 95% CI 0.2, 0.4] while preterm infants who had symptoms of infection [RR 5.6; 95% CI 4.3, 7.1] or whose mother suffered antenatal complications [RR 1.4; 95% CI 1.1, 1.8] were at higher mortality risk. Elimination of excess neonatal deaths caused by preterm would decrease population-level neonatal mortality rate by 31.0% [95% CI 27.60%, 34.5%].
  
  
  CONCLUSIONS
  Given that 87% of preterm births and 60% of preterm deaths were in late or moderate preterm infants, and that 87% preterm babies received a visit from CHW within third day of life, a home-based essential care package delivered by CHWs for sick preterm infants, specifically focused on birth preparedness, skin-to-skin care, immediate breast feeding, early recognition of danger signs, and linked through referral to intensive and quality care in health facilities, could be an effective approach in low resource settings.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Health and Nutrition, Save the Children-USA, Washington, DC.
authors.forename: Rashed
authors.initials: R
authors.lastname: Shah
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Radwanur Rahman
authors.initials: RR
authors.lastname: Talukder
authors.forename: Syed Moshfiqur
authors.initials: SM
authors.lastname: Rahman
authors.forename: Ishtiaq
authors.initials: I
authors.lastname: Mannan
authors.forename: Shams El
authors.initials: SE
authors.lastname: Arifeen
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001942:Breast Feeding; D004522:Educational Status; D005260:Female; D006266:Health Education; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000517:prevention & control*; D060127:Kangaroo-Mother Care Method; D008297:Male; D044342:Malnutrition / Q000401:mortality*; D008425:Maternal Behavior; D009034:Mother-Child Relations; D011181:Postnatal Care / Q000379:methods*; D011204:Poverty Areas; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000517:prevention & control*; D047928:Premature Birth / Q000401:mortality*; D011295:Prenatal Care; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Bangladesh; mortality risk; neonatal mortality; preterm birth