title: Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal.
abstract: BACKGROUND
  Globally, 15 million babies were born prematurely in 2012, with 37.6 % of them in South Asia. About 32.4 million infants were born small for gestational age (SGA) in 2010, with more than half of these births occurring in South Asia. In Nepal, 14 % of babies were born preterm and 39.3 % were born SGA in 2010. We conducted a study in a tertiary hospital of Nepal to assess the level of risk for neonatal mortality among babies who were born prematurely and/or SGA.
  
  
  METHODS
  This case-control study was completed over a 15-month period between July 2012 and September 2013. All neonatal deaths that occurred during the study period were included as cases and 20 % of women with live births were randomly selected as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analyses were conducted to determine the level of risk for neonatal mortality among babies born preterm and/or SGA.
  
  
  RESULTS
  During this period, the hospital had an incidence of preterm birth and SGA of 8.1 and 37.5%, respectively. In the multivariate model, there was a 12-fold increased risk of neonatal death among preterm infants compared to term. Babies who were SGA had a 40 % higher risk of neonatal death compared to those who were not. Additionally, babies who were both preterm and SGA were 16 times more likely to die during the neonatal period.
  
  
  CONCLUSIONS
  Our study showed that the risk of neonatal mortality was highest when the baby was born both preterm and SGA, followed by babies who were born preterm, and then by babies who were SGA in a tertiary hospital in Nepal. In tertiary care settings, the risk of mortality for babies who are born preterm and/or SGA can be reduced with low-cost interventions such as Kangaroo Mother Care or improved management of complications through special newborn care or neonatal intensive care units. The risk of death for babies who are born prematurely and/or SGA can thus be used as an indicator to monitor the quality of care for these babies in health facility settings.
  
  
  BACKGROUND
  ISRCTN97846009.
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. aaashis7@yahoo.com.|United Nation's Children's Fund, Nepal Country Office, UN House Pulchowk, Lalitpur, Nepal. aaashis7@yahoo.com.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kc
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. johan.wrammert@kbh.uu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Wrammert
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. viktorianelin@gmail.com.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Nelin
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. uwe.ewald@kbh.uu.se.
authors.forename: Uwe
authors.initials: U
authors.lastname: Ewald
authors.affiliation: Latter Day Saints Charities, Salt Lake City, Utah, USA. robclarkmd@outlook.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Clark
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. mats.malqvist@kbh.uu.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Målqvist
mesh_terms: D000328:Adult; D001208:Asia; D001724:Birth Weight; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D008297:Male; D009390:Nepal / Q000453:epidemiology; D066087:Perinatal Death / Q000209:etiology*; D047928:Premature Birth / Q000453:epidemiology; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult