{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T04:23:05Z","timestamp":1775535785183,"version":"3.50.1"},"reference-count":44,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T00:00:00Z","timestamp":1580083200000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP614"],"award-info":[{"award-number":["OPP614"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2019,12,10]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the extent to which maternal histories of newborn danger signs independently or combined with birth weight and\/or gestational age (GA) can capture and\/or predict postsecond day (age&gt;48\u2009hours) neonatal death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from a cluster-randomised trial conducted in rural Bangladesh were split into development and validation sets. The prompted recall of danger signs and birth weight measurements were collected within 48\u2009hours postchildbirth. Maternally recalled danger signs included cyanosis (any part of the infant\u2019s body was blue at birth), non-cephalic presentation (part other than head came out first at birth), lethargy (weak or no arm\/leg movement and\/or cry at birth), trouble suckling (infant unable to suckle\/feed normally in the 2\u2009days after birth or before death, collected 1-month postpartum or from verbal autopsy). Last menstrual period was collected at maternal enrolment early in pregnancy. Singleton newborns surviving 2\u2009days past childbirth were eligible for analysis. Prognostic multivariable models were developed and internally validated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Recalling \u22651\u2009sign of lethargy, cyanosis, non-cephalic presentation or trouble suckling identified postsecond day neonatal death with 65.3% sensitivity, 60.8% specificity, 2.1% positive predictive value (PPV) and 99.3% negative predictive value (NPV) in the development set. Requiring either lethargy or weight &lt;2.5 kg identified 89.1% of deaths (at 39.7% specificity, 1.9% PPV and 99.6% NPV) while lethargy or preterm birth (&lt;37 weeks) captured 81.0% of deaths (at 53.6% specificity, 2.3% PPV and 99.5% NPV). A simplified model (birth weight, GA, lethargy, cyanosis, non-cephalic presentation and trouble suckling) predicted death with good discrimination (validation area under the receiver-operator characteristic curve (AUC) 0.80, 95%\u2009CI 0.73 to 0.87). A further simplified model (GA, non-cephalic presentation, lethargy, trouble suckling) predicted death with moderate discrimination (validation AUC 0.74, 95%\u2009CI 0.66 to 0.81).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Maternally recalled danger signs, coupled to either birth weight or GA, can predict and capture postsecond day neonatal death with high discrimination and sensitivity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2019-001983","type":"journal-article","created":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T05:05:31Z","timestamp":1580187931000},"page":"e001983","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Predictors of neonatal mortality: development and validation of prognostic models using prospective data from rural Bangladesh"],"prefix":"10.1136","volume":"5","clinical-trial-number":[{"clinical-trial-number":"nct00860470","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2027-8953","authenticated-orcid":false,"given":"Farhad A","family":"Khan","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4668-9803","authenticated-orcid":false,"given":"Luke C","family":"Mullany","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee F-S","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0044-1992","authenticated-orcid":false,"given":"Hasmot","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-1478","authenticated-orcid":false,"given":"Saijuddin","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-6308","authenticated-orcid":false,"given":"Kelsey","family":"Alland","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-362X","authenticated-orcid":false,"given":"Keith P","family":"West Jr","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-7819","authenticated-orcid":false,"given":"Alain B","family":"Labrique","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,1,27]]},"reference":[{"key":"2025072915212351000_5.1.e001983.1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every newborn: progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014","journal-title":"The Lancet"},{"key":"2025072915212351000_5.1.e001983.2","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: an updated systematic analysis with implications for the sustainable development goals","volume":"388","author":"Liu","year":"2016","journal-title":"The Lancet"},{"key":"2025072915212351000_5.1.e001983.3","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(05)71048-5","article-title":"4 million neonatal deaths: when? where? why?","volume":"365","author":"Lawn","year":"2005","journal-title":"The Lancet"},{"key":"2025072915212351000_5.1.e001983.4","doi-asserted-by":"crossref","unstructured":"Winter R , Yourkavitch J , Wang W , et al . 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