{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:57:58Z","timestamp":1792184278710,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,6,5]],"date-time":"2022-06-05T00:00:00Z","timestamp":1654387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective, observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>Study NICUs in India and Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Preterm infants delivered in study facility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>RDS and birth asphyxia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17220","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T07:47:55Z","timestamp":1653032875000},"page":"1993-2000","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Birth asphyxia is under\u2010rated as a cause of preterm neonatal mortality in low\u2010 and middle\u2010income countries: A prospective, observational study from PURPOSe"],"prefix":"10.1111","volume":"129","author":[{"given":"Robert L.","family":"Goldenberg","sequence":"first","affiliation":[{"name":"Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangappa","family":"Dhaded","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research's J N Medical College  Belagavi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-7053","authenticated-orcid":false,"given":"Shivaprasad S.","family":"Goudar","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research's J N Medical College  Belagavi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyam Sunder","family":"Tikmani","sequence":"additional","affiliation":[{"name":"Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Trotta","sequence":"additional","affiliation":[{"name":"RTI International  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"Hwang Jackson","sequence":"additional","affiliation":[{"name":"RTI International  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowder","family":"Guruprasad","sequence":"additional","affiliation":[{"name":"Bapuji Educational Association's, J.J.M. 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