SEPTEMBER – OCTOBER 2023
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Go beyond classic classifications to assess the risk of death and long-term complications would allow us to focus efforts on those who really need it most and implement preventive interventions.
By Mag. Verónica Pingray*
Although the classic way to identify newborns with a higher risk of neonatal death or long-term complications is to evaluate whether they are premature or weigh less than 2,5 kg when they are born, together with an international group of researchers we set out to classify them into 6 subtypes or “phenotypes” based on easily accessible data, which could be a practical alternative to detect those who are most vulnerable.
If it is found that, as we think, some of these subtypes are associated with a higher risk of mortality, this may have implications in terms of public policy programming and health programming, because efforts could be focused on those who really need it most and implement preventive interventions.
The research is framed in a initiative of London School of Economics so that premature children, with low birth weight and low size for gestational age can be designated under the umbrella term of “small vulnerable newborns”, which could favor the design and implementation of public health measures aimed at preventing them.
For the new study, published in BJOG- An International Journal of Obstetrics and Gynecology (see here), we reviewed public data on 165 million babies born alive between 2000 and 2021 in 23 high- and middle-income countries, including Argentina. Based on the intersection of gestational age (the age of a baby from the first day of the mother's last menstrual period), size and weight at birth, 6 subtypes or “phenotypes” of newborns could be constructed:
- Premature and small for gestational age
- Premature and appropriate size for gestational age
- Premature and large for gestational age
- Born at term, but small for gestational age
- Born at term and large for gestational age
- Born at term and size appropriate for gestational age
The first 4 phenotypes correspond to “small” vulnerable newborns, which are premature and/or small for gestational age; and the fifth corresponds to another vulnerable group, the “large ones”, which are those born at term and large for gestational age, in other words, who weigh more than 90% of babies of gestational age.
And they are not a negligible proportion of live newborns. If the databases of the countries are analyzed, just over 11% of the total are “small” vulnerable, with Malaysia (26%) and Qatar (15,7%) leading that ranking, although Brazil, Argentina and Mexico are also close by. above average. On the contrary, those of the “large” type are more frequent in Europe, representing, for example, 28,8% in Estonia and 24,9% in Denmark.
These analyzes provide a baseline overview of the types of vulnerable newborns, although a next step requires examining these groups with respect to mortality as well as the lifetime impact of being born within the various size classifications. and gestational age.
*Verónica Pingray has a degree in obstetrics, a master's degree in public health and a Researcher at the Department of Mother and Child Health of the IECS.