{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:04:48Z","timestamp":1789977888389,"version":"4.0.1"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neonatal-Perinatal Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Conventional perinatal death review assigns a principal cause despite overlapping pathways. We examined whether outcome-specific latent classes could complement conventional classification and whether structured markers could inform review of unexplained deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this secondary analysis, 588 expert-adjudicated deaths from 18 Jordanian hospitals (261 stillbirths, 327 neonatal deaths) were analyzed. Gestational age was modeled as mutually exclusive categories (&lt;32, 32\u201336, \u226537 weeks) with eight outcome-specific binary markers. Model selection considered Bayesian information criterion (BIC), classification quality, parsimony, and stability to hospital omission and one-death-per-pregnancy resampling. Expert care-quality and preventability judgments were auxiliary outcomes. Marker hierarchies were applied to 192 unexplained\/unclassifiable deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Stillbirths supported one class (BIC 2357.4), stable in all sensitivity analyses. For neonatal deaths, two- and three-class BIC values were nearly identical (3398.8 vs 3397.6); the two-class solution had better classification quality and stability and was retained. It comprised a preterm respiratory\/multiple-birth phenotype (n = 204) and a later-gestation congenital-asphyxial\/sepsis phenotype (n = 123); definite preventability was 20.1% and 46.7%, respectively. Marker hierarchies assigned 149\/192 deaths (77.6%) to marker-supported groups, leaving 43 (22.4%) unexplained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Available stillbirth indicators did not support latent subclasses. Neonatal deaths showed clinically interpretable heterogeneity, although class enumeration remained uncertain. Marker-supported grouping can recover residual clinical information but is order-dependent and does not establish cause or validate preventability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19345798261490604","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:27:58Z","timestamp":1789734478000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond single cause-of-death labels: A secondary analysis of outcome-specific latent-class phenotyping and marker-supported reclassification of stillbirths and neonatal deaths in Jordan"],"prefix":"10.1177","author":[{"given":"Yousef","family":"Khader","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Jordan University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alyahya","sequence":"additional","affiliation":[{"name":"Jordan University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_5_2_2","volume-title":"Standing up for stillbirth: current estimates and key interventions","author":"United Nations Inter-agency Group for Child Mortality Estimation","year":"2025","unstructured":"United Nations Inter-agency Group for Child Mortality Estimation. Standing up for stillbirth: current estimates and key interventions. UNICEF, 2025."},{"key":"e_1_3_5_3_2","volume-title":"Levels & trends in child mortality: report 2024 - estimates developed by the united nations inter-Agency group for child mortality estimation","author":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)","year":"2025","unstructured":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & trends in child mortality: report 2024 - estimates developed by the united nations inter-Agency group for child mortality estimation. 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Wiley, 2010."},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/10705510701575396"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-015-1892-x"},{"issue":"8","key":"e_1_3_5_21_2","first-page":"1307","article-title":"Stillbirths in Jordan: rate, causes, and preventability","volume":"33","author":"Khader YS","year":"2020","unstructured":"Khader YS, Batieha A, Khader A, et al. Stillbirths in Jordan: rate, causes, and preventability. J Matern Fetal Neonatal Med 2020; 33(8): 1307\u20131314. https:\/\/doi.org\/10.1080\/14767058.2018.1517326","journal-title":"J Matern Fetal Neonatal Med"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.2196\/11653"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.2196\/29143"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-025-01993-4"},{"key":"e_1_3_5_25_2","volume-title":"Making every baby count: audit and review of stillbirths and neonatal deaths","author":"World Health Organization","year":"2016","unstructured":"World Health Organization. Making every baby count: audit and review of stillbirths and neonatal deaths. 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