Impact of small for gestational age infants by updated local curve on neonatal mortality in Indonesia

Abstract

Abstract ObjectivesTo study early neonatal and neonatal mortality of small for gestational age (SGA) infants using the updated newborn curveMethodsA retrospective cohort study on all live births was conducted in Sleman and Sardjito hospital, Yogyakarta. Analysis was made with Kaplan-Meier, multivariate with Cox Hazard, and Population Attributable Risk (PAR). ResultThere were 35,649 live births eligible for the study. Early neonatal death by gestational age using the analysis of Kaplan Meier revealed the highest cumulative mortality incident (CMI) in preterm SGA. Respiratory distress was the highest risk with Hazard ratio (HR) 9.46, followed by asphyxia with HR 5.08, mother’s death with HR 2.27, extra-health facility with HR 1.97, Symmetrical SGA with HR 1.97, preterm appropriate gestational age (AGA) with HR 1.75, low birth weight (LBW) with HR 1.64, primary health facility with HR 1.33 and boys with HR 1.16 consecutively. Similar result was found in the neonatal mortality.Estimated highest PAR of early neonatal mortality in LBW SGA was 11.98, while LBW AGA was 6.07, whereas by gestational age the highest was in gestational age <28 weeks with PAR 25.13, followed by premature babies whose value decreased as their the gestational age increased. Similar result was identified in neonatal mortalityConclusionLocal updated newborn curve based on gestational age of early neonatal and neonatal mortality showed the highest CMI in preterm SGA. Estimated highest PAR in early neonatal and neonatal mortality was found in LBW SGA and preterm infants.