{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:31:34Z","timestamp":1781713894465,"version":"3.54.5"},"reference-count":44,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T00:00:00Z","timestamp":1694649600000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["OPP1084399"],"award-info":[{"award-number":["OPP1084399"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institute for Child Health and Human Development","award":["R01HD060712"],"award-info":[{"award-number":["R01HD060712"]}]},{"name":"National Institute for Child Health and Human Development","award":["R01HD092411"],"award-info":[{"award-number":["R01HD092411"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,8,31]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and\/or preterm) and neonatal mortality in rural Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Rural Sarlahi district, Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>40\u2009119 pregnant women enrolled from 9 September 2010 to 16 January 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 32\u2009004 live births and 998 neonatal deaths. SGA and\/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95%\u2009CI: (4.44 to 11.31)), SGA and term\/post-term (aHR: 2.12, 95%\u2009CI: (1.58 to 2.86)), appropriate-for-gestational-age\/large-for-gestational-age and preterm (aHR: 3.23, 95%\u2009CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95%\u2009CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95%\u2009CI: (4.25 to 7.48)), births at health posts\/clinics or in hospital (aHR: 1.34, 95%\u2009CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95%\u2009CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from &lt;145\u2009cm to 145\u2013150\u2009cm (aHR: 0.78, 95%\u2009CI: (0.65 to 0.94)) to \u2265150\u2009cm (aHR: 0.57, 95%\u2009CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95%\u2009CI: (0.53 to 0.86)) and education &gt;5 years (aHR: 0.75, 95%\u2009CI: (0.62 to 0.92)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SGA and\/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01177111\">NCT01177111<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-066931","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T13:30:57Z","timestamp":1694698257000},"page":"e066931","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct01177111","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01177111","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6667-4348","authenticated-orcid":false,"given":"Tingting","family":"Yan","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke C","family":"Mullany","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6360-3998","authenticated-orcid":false,"given":"Seema","family":"Subedi","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9176-3278","authenticated-orcid":false,"given":"Elizabeth A","family":"Hazel","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subarna K","family":"Khatry","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"},{"name":"Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diwakar","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Zeger","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Tielsch","sequence":"additional","affiliation":[{"name":"Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C","family":"LeClerq","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"},{"name":"Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,9,14]]},"reference":[{"key":"2025121513252967000_13.9.e066931.1","unstructured":"United Nations International Children\u2019s Emergency Fund, Unicef . 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