The distribution of clinical phenotypes of preterm birth syndrome implications for prevention

Fernando C. Barros, Aris T. Papageorghiou, Cesar G. Victora, Julia A. Noble, Ruyan Pang, Jay Iams, Leila Cheikh Ismail, Robert L. Goldenberg, Ann Lambert, Michael S. Kramer, Maria Carvalho, Agustin Conde-Agudelo, Yasmin A. Jaffer, Enrico Bertino, Michael G. Gravett, Doug G. Altman, Eric O. Ohuma, Manorama Purwar, Ihunnaya O. Frederick, Zulfiqar A. BhuttaStephen H. Kennedy, José Villar, M. Katz, M. K. Bhan, C. Garza, S. Zaidi, A. Langer, P. M. Rothwell, D. Weatherall, F. Burton, W. C. Chumlea, P. Lumbiganon, J. Rivera, S. Kennedy, M. Shorten, L. Hoch, H. E. Knight, C. Cosgrove, I. Blakey, F. Roseman, N. Kunnawar, S. H. Gu, J. H. Wang, M. Domingues, P. Gilli, L. Juodvirsiene, N. Musee, H. Al-Jabri, S. Waller, D. Muninzwa, D. Yellappan, A. Carter, D. Reade, R. Miller, L. Salomon, A. Leston, A. Mitidieri, F. Al-Aamri, W. Paulsene, J. Sande, W. K S Al-Zadjali, C. Batiuk, S. Bornemeier, M. Dighe, P. Gaglioti, N. Jacinta, S. Jaiswal, K. Oas, M. Oberto, E. Olearo, M. G. Owende, J. Shah, S. Sohoni, T. Todros, M. Venkataraman, S. Vinayak, L. Wang, D. Wilson, Q. Q. Wu, P. Chamberlain, D. Danelon, I. Sarris, J. Dhami, C. Ioannou, C. L. Knight, R. Napolitano, S. Wanyonyi, C. Pace, V. Mkrtychyan, L. Cheikh Ismail, M. Alija, J. M. Jimenez-Bustos, J. Kizidio, F. Puglia, H. Liu, S. Lloyd, D. Mota, R. Ochieng, C. Rossi, M. Sanchez Luna, Y. J. Shen, D. A. Rocco, E. Albernaz, M. Batra, B. A. Bhat, P. Di Nicola, F. Giuliani, I. Rovelli, K. McCormick, V. Paul, V. Rajan, A. Wilkinson, A. Varalda, B. Eskenazi, L. A. Corra, H. Dolk, J. Golding, A. Matijasevich, T. De Wet, J. J. Zhang, A. Bradman, D. Finkton, O. Burnham, F. Farhi, S. Fonseca, I. K. Sclowitz, M. F. Da Silveira, R. Y. Pang, Y. P. He, Y. Pan, M. H. Wu, Y. Yuan, Y. Zhang, A. Choudhary, S. Choudhary, S. Deshmukh, D. Dongaonkar, M. Ketkar, V. Khedikar, C. Mahorkar, I. Mulik, K. Saboo, C. Shembekar, A. Singh, V. Taori, K. Tayade, A. Somani, M. Frigerio, G. Gilli, M. Giolito, L. Occhi, F. Signorile, M. Carvalho, W. Stones, C. Kisiangani, J. Al-Abri, J. Al-Abduwani, F. M. Al-Habsi, H. Al-Lawatiya, B. Al-Rashidiya, F. R. Juangco, H. F. Andersen, S. E. Abbott, A. A. Carter, H. Algren, T. K. Sorensen, D. Enquobahrie

Research output: Contribution to journalArticle

Abstract

Importance:Preterm birth has been difficult to study and prevent because of its complex syndromic nature.OBJECTIVE To identify phenotypes of preterm delivery syndrome in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Design, Setting, and Participants:A population-based, multiethnic, cross-sectional study conducted at 8 geographically demarcated sites in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States. A total of 60 058 births over a 12-month fixed period between April 27, 2009, and March 2, 2014. Of these, 53 871 had an ultrasonography estimate of gestational age, among which 5828 were preterm births (10.8%). Pregnancies were prospectively studied using a standardized data collection and online data management system. Newborns had anthropometric and clinical examinations using standardized methods and identical equipment and were followed up until hospital discharge.Main Outcomes and Measures: The main study outcomeswere clusters of preterm phenotypes and for each cluster, we analyzed signs of presentation at hospital admission, admission rates for neonatal intensive care for 7 days or more, and neonatal mortality rates.Results: Twelve preterm birth clusters were identified using our conceptual framework. Eleven consisted of combinations of conditions known to be associated with preterm birth, 10 of which were dominated by a single condition. However, themost common single cluster (30.0%of the total preterm cases; n = 1747) was not associated with any severe maternal, fetal, or placental condition that was clinically detectable based on the information available; within this cluster, many cases were caregiver initiated. Only 22%(n = 1284) of all the preterm births occurred spontaneously without any of these severe conditions. Maternal presentation on hospital admission, newborn anthropometry, and risk for death before hospital discharge or admission for 7 or more days to a neonatal intensive care unit, none of which were used to construct the clusters, also differed according to the identified phenotypes. The prevalence of preterm birth ranged from 8.2%in Muscat, Oman, and Oxford, England, to 16.6%in Seattle,Washington.Conclusions and Relevance: We identified 12 preterm birth phenotypes associated with different patterns of neonatal outcomes. In 22%of all preterm births, parturition started spontaneously and was not associated with any of the phenotypic conditions considered.We believe these results contribute to an improved understanding of this complex syndrome and provide an empirical basis to focus research on a more homogenous set of phenotypes.

Original languageEnglish (US)
Pages (from-to)220-229
Number of pages10
JournalJAMA Pediatrics
Volume169
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

Hospital Distribution Systems
Premature Birth
Phenotype
Oman
Newborn Infant
Cross-Sectional Studies
Mothers
Parturition
Neonatal Intensive Care
Anthropometry
Kenya
Neonatal Intensive Care Units
Infant Mortality
Information Systems
England
Italy
Caregivers
Gestational Age
Brazil
India

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Barros, F. C., Papageorghiou, A. T., Victora, C. G., Noble, J. A., Pang, R., Iams, J., ... Enquobahrie, D. (2015). The distribution of clinical phenotypes of preterm birth syndrome implications for prevention. JAMA Pediatrics, 169(3), 220-229. https://doi.org/10.1001/jamapediatrics.2014.3040

The distribution of clinical phenotypes of preterm birth syndrome implications for prevention. / Barros, Fernando C.; Papageorghiou, Aris T.; Victora, Cesar G.; Noble, Julia A.; Pang, Ruyan; Iams, Jay; Ismail, Leila Cheikh; Goldenberg, Robert L.; Lambert, Ann; Kramer, Michael S.; Carvalho, Maria; Conde-Agudelo, Agustin; Jaffer, Yasmin A.; Bertino, Enrico; Gravett, Michael G.; Altman, Doug G.; Ohuma, Eric O.; Purwar, Manorama; Frederick, Ihunnaya O.; Bhutta, Zulfiqar A.; Kennedy, Stephen H.; Villar, José; Katz, M.; Bhan, M. K.; Garza, C.; Zaidi, S.; Langer, A.; Rothwell, P. M.; Weatherall, D.; Burton, F.; Chumlea, W. C.; Lumbiganon, P.; Rivera, J.; Kennedy, S.; Shorten, M.; Hoch, L.; Knight, H. E.; Cosgrove, C.; Blakey, I.; Roseman, F.; Kunnawar, N.; Gu, S. H.; Wang, J. H.; Domingues, M.; Gilli, P.; Juodvirsiene, L.; Musee, N.; Al-Jabri, H.; Waller, S.; Muninzwa, D.; Yellappan, D.; Carter, A.; Reade, D.; Miller, R.; Salomon, L.; Leston, A.; Mitidieri, A.; Al-Aamri, F.; Paulsene, W.; Sande, J.; Al-Zadjali, W. K S; Batiuk, C.; Bornemeier, S.; Dighe, M.; Gaglioti, P.; Jacinta, N.; Jaiswal, S.; Oas, K.; Oberto, M.; Olearo, E.; Owende, M. G.; Shah, J.; Sohoni, S.; Todros, T.; Venkataraman, M.; Vinayak, S.; Wang, L.; Wilson, D.; Wu, Q. Q.; Chamberlain, P.; Danelon, D.; Sarris, I.; Dhami, J.; Ioannou, C.; Knight, C. L.; Napolitano, R.; Wanyonyi, S.; Pace, C.; Mkrtychyan, V.; Cheikh Ismail, L.; Alija, M.; Jimenez-Bustos, J. M.; Kizidio, J.; Puglia, F.; Liu, H.; Lloyd, S.; Mota, D.; Ochieng, R.; Rossi, C.; Sanchez Luna, M.; Shen, Y. J.; Rocco, D. A.; Albernaz, E.; Batra, M.; Bhat, B. A.; Di Nicola, P.; Giuliani, F.; Rovelli, I.; McCormick, K.; Paul, V.; Rajan, V.; Wilkinson, A.; Varalda, A.; Eskenazi, B.; Corra, L. A.; Dolk, H.; Golding, J.; Matijasevich, A.; De Wet, T.; Zhang, J. J.; Bradman, A.; Finkton, D.; Burnham, O.; Farhi, F.; Fonseca, S.; Sclowitz, I. K.; Da Silveira, M. F.; Pang, R. Y.; He, Y. P.; Pan, Y.; Wu, M. H.; Yuan, Y.; Zhang, Y.; Choudhary, A.; Choudhary, S.; Deshmukh, S.; Dongaonkar, D.; Ketkar, M.; Khedikar, V.; Mahorkar, C.; Mulik, I.; Saboo, K.; Shembekar, C.; Singh, A.; Taori, V.; Tayade, K.; Somani, A.; Frigerio, M.; Gilli, G.; Giolito, M.; Occhi, L.; Signorile, F.; Carvalho, M.; Stones, W.; Kisiangani, C.; Al-Abri, J.; Al-Abduwani, J.; Al-Habsi, F. M.; Al-Lawatiya, H.; Al-Rashidiya, B.; Juangco, F. R.; Andersen, H. F.; Abbott, S. E.; Carter, A. A.; Algren, H.; Sorensen, T. K.; Enquobahrie, D.

In: JAMA Pediatrics, Vol. 169, No. 3, 01.03.2015, p. 220-229.

Research output: Contribution to journalArticle

Barros, FC, Papageorghiou, AT, Victora, CG, Noble, JA, Pang, R, Iams, J, Ismail, LC, Goldenberg, RL, Lambert, A, Kramer, MS, Carvalho, M, Conde-Agudelo, A, Jaffer, YA, Bertino, E, Gravett, MG, Altman, DG, Ohuma, EO, Purwar, M, Frederick, IO, Bhutta, ZA, Kennedy, SH, Villar, J, Katz, M, Bhan, MK, Garza, C, Zaidi, S, Langer, A, Rothwell, PM, Weatherall, D, Burton, F, Chumlea, WC, Lumbiganon, P, Rivera, J, Kennedy, S, Shorten, M, Hoch, L, Knight, HE, Cosgrove, C, Blakey, I, Roseman, F, Kunnawar, N, Gu, SH, Wang, JH, Domingues, M, Gilli, P, Juodvirsiene, L, Musee, N, Al-Jabri, H, Waller, S, Muninzwa, D, Yellappan, D, Carter, A, Reade, D, Miller, R, Salomon, L, Leston, A, Mitidieri, A, Al-Aamri, F, Paulsene, W, Sande, J, Al-Zadjali, WKS, Batiuk, C, Bornemeier, S, Dighe, M, Gaglioti, P, Jacinta, N, Jaiswal, S, Oas, K, Oberto, M, Olearo, E, Owende, MG, Shah, J, Sohoni, S, Todros, T, Venkataraman, M, Vinayak, S, Wang, L, Wilson, D, Wu, QQ, Chamberlain, P, Danelon, D, Sarris, I, Dhami, J, Ioannou, C, Knight, CL, Napolitano, R, Wanyonyi, S, Pace, C, Mkrtychyan, V, Cheikh Ismail, L, Alija, M, Jimenez-Bustos, JM, Kizidio, J, Puglia, F, Liu, H, Lloyd, S, Mota, D, Ochieng, R, Rossi, C, Sanchez Luna, M, Shen, YJ, Rocco, DA, Albernaz, E, Batra, M, Bhat, BA, Di Nicola, P, Giuliani, F, Rovelli, I, McCormick, K, Paul, V, Rajan, V, Wilkinson, A, Varalda, A, Eskenazi, B, Corra, LA, Dolk, H, Golding, J, Matijasevich, A, De Wet, T, Zhang, JJ, Bradman, A, Finkton, D, Burnham, O, Farhi, F, Fonseca, S, Sclowitz, IK, Da Silveira, MF, Pang, RY, He, YP, Pan, Y, Wu, MH, Yuan, Y, Zhang, Y, Choudhary, A, Choudhary, S, Deshmukh, S, Dongaonkar, D, Ketkar, M, Khedikar, V, Mahorkar, C, Mulik, I, Saboo, K, Shembekar, C, Singh, A, Taori, V, Tayade, K, Somani, A, Frigerio, M, Gilli, G, Giolito, M, Occhi, L, Signorile, F, Carvalho, M, Stones, W, Kisiangani, C, Al-Abri, J, Al-Abduwani, J, Al-Habsi, FM, Al-Lawatiya, H, Al-Rashidiya, B, Juangco, FR, Andersen, HF, Abbott, SE, Carter, AA, Algren, H, Sorensen, TK & Enquobahrie, D 2015, 'The distribution of clinical phenotypes of preterm birth syndrome implications for prevention', JAMA Pediatrics, vol. 169, no. 3, pp. 220-229. https://doi.org/10.1001/jamapediatrics.2014.3040
Barros FC, Papageorghiou AT, Victora CG, Noble JA, Pang R, Iams J et al. The distribution of clinical phenotypes of preterm birth syndrome implications for prevention. JAMA Pediatrics. 2015 Mar 1;169(3):220-229. https://doi.org/10.1001/jamapediatrics.2014.3040
Barros, Fernando C. ; Papageorghiou, Aris T. ; Victora, Cesar G. ; Noble, Julia A. ; Pang, Ruyan ; Iams, Jay ; Ismail, Leila Cheikh ; Goldenberg, Robert L. ; Lambert, Ann ; Kramer, Michael S. ; Carvalho, Maria ; Conde-Agudelo, Agustin ; Jaffer, Yasmin A. ; Bertino, Enrico ; Gravett, Michael G. ; Altman, Doug G. ; Ohuma, Eric O. ; Purwar, Manorama ; Frederick, Ihunnaya O. ; Bhutta, Zulfiqar A. ; Kennedy, Stephen H. ; Villar, José ; Katz, M. ; Bhan, M. K. ; Garza, C. ; Zaidi, S. ; Langer, A. ; Rothwell, P. M. ; Weatherall, D. ; Burton, F. ; Chumlea, W. C. ; Lumbiganon, P. ; Rivera, J. ; Kennedy, S. ; Shorten, M. ; Hoch, L. ; Knight, H. E. ; Cosgrove, C. ; Blakey, I. ; Roseman, F. ; Kunnawar, N. ; Gu, S. H. ; Wang, J. H. ; Domingues, M. ; Gilli, P. ; Juodvirsiene, L. ; Musee, N. ; Al-Jabri, H. ; Waller, S. ; Muninzwa, D. ; Yellappan, D. ; Carter, A. ; Reade, D. ; Miller, R. ; Salomon, L. ; Leston, A. ; Mitidieri, A. ; Al-Aamri, F. ; Paulsene, W. ; Sande, J. ; Al-Zadjali, W. K S ; Batiuk, C. ; Bornemeier, S. ; Dighe, M. ; Gaglioti, P. ; Jacinta, N. ; Jaiswal, S. ; Oas, K. ; Oberto, M. ; Olearo, E. ; Owende, M. G. ; Shah, J. ; Sohoni, S. ; Todros, T. ; Venkataraman, M. ; Vinayak, S. ; Wang, L. ; Wilson, D. ; Wu, Q. Q. ; Chamberlain, P. ; Danelon, D. ; Sarris, I. ; Dhami, J. ; Ioannou, C. ; Knight, C. L. ; Napolitano, R. ; Wanyonyi, S. ; Pace, C. ; Mkrtychyan, V. ; Cheikh Ismail, L. ; Alija, M. ; Jimenez-Bustos, J. M. ; Kizidio, J. ; Puglia, F. ; Liu, H. ; Lloyd, S. ; Mota, D. ; Ochieng, R. ; Rossi, C. ; Sanchez Luna, M. ; Shen, Y. J. ; Rocco, D. A. ; Albernaz, E. ; Batra, M. ; Bhat, B. A. ; Di Nicola, P. ; Giuliani, F. ; Rovelli, I. ; McCormick, K. ; Paul, V. ; Rajan, V. ; Wilkinson, A. ; Varalda, A. ; Eskenazi, B. ; Corra, L. A. ; Dolk, H. ; Golding, J. ; Matijasevich, A. ; De Wet, T. ; Zhang, J. J. ; Bradman, A. ; Finkton, D. ; Burnham, O. ; Farhi, F. ; Fonseca, S. ; Sclowitz, I. K. ; Da Silveira, M. F. ; Pang, R. Y. ; He, Y. P. ; Pan, Y. ; Wu, M. H. ; Yuan, Y. ; Zhang, Y. ; Choudhary, A. ; Choudhary, S. ; Deshmukh, S. ; Dongaonkar, D. ; Ketkar, M. ; Khedikar, V. ; Mahorkar, C. ; Mulik, I. ; Saboo, K. ; Shembekar, C. ; Singh, A. ; Taori, V. ; Tayade, K. ; Somani, A. ; Frigerio, M. ; Gilli, G. ; Giolito, M. ; Occhi, L. ; Signorile, F. ; Carvalho, M. ; Stones, W. ; Kisiangani, C. ; Al-Abri, J. ; Al-Abduwani, J. ; Al-Habsi, F. M. ; Al-Lawatiya, H. ; Al-Rashidiya, B. ; Juangco, F. R. ; Andersen, H. F. ; Abbott, S. E. ; Carter, A. A. ; Algren, H. ; Sorensen, T. K. ; Enquobahrie, D. / The distribution of clinical phenotypes of preterm birth syndrome implications for prevention. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 3. pp. 220-229.
@article{8337c6eae50b4202916797d1e2d684a4,
title = "The distribution of clinical phenotypes of preterm birth syndrome implications for prevention",
abstract = "Importance:Preterm birth has been difficult to study and prevent because of its complex syndromic nature.OBJECTIVE To identify phenotypes of preterm delivery syndrome in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Design, Setting, and Participants:A population-based, multiethnic, cross-sectional study conducted at 8 geographically demarcated sites in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States. A total of 60 058 births over a 12-month fixed period between April 27, 2009, and March 2, 2014. Of these, 53 871 had an ultrasonography estimate of gestational age, among which 5828 were preterm births (10.8{\%}). Pregnancies were prospectively studied using a standardized data collection and online data management system. Newborns had anthropometric and clinical examinations using standardized methods and identical equipment and were followed up until hospital discharge.Main Outcomes and Measures: The main study outcomeswere clusters of preterm phenotypes and for each cluster, we analyzed signs of presentation at hospital admission, admission rates for neonatal intensive care for 7 days or more, and neonatal mortality rates.Results: Twelve preterm birth clusters were identified using our conceptual framework. Eleven consisted of combinations of conditions known to be associated with preterm birth, 10 of which were dominated by a single condition. However, themost common single cluster (30.0{\%}of the total preterm cases; n = 1747) was not associated with any severe maternal, fetal, or placental condition that was clinically detectable based on the information available; within this cluster, many cases were caregiver initiated. Only 22{\%}(n = 1284) of all the preterm births occurred spontaneously without any of these severe conditions. Maternal presentation on hospital admission, newborn anthropometry, and risk for death before hospital discharge or admission for 7 or more days to a neonatal intensive care unit, none of which were used to construct the clusters, also differed according to the identified phenotypes. The prevalence of preterm birth ranged from 8.2{\%}in Muscat, Oman, and Oxford, England, to 16.6{\%}in Seattle,Washington.Conclusions and Relevance: We identified 12 preterm birth phenotypes associated with different patterns of neonatal outcomes. In 22{\%}of all preterm births, parturition started spontaneously and was not associated with any of the phenotypic conditions considered.We believe these results contribute to an improved understanding of this complex syndrome and provide an empirical basis to focus research on a more homogenous set of phenotypes.",
author = "Barros, {Fernando C.} and Papageorghiou, {Aris T.} and Victora, {Cesar G.} and Noble, {Julia A.} and Ruyan Pang and Jay Iams and Ismail, {Leila Cheikh} and Goldenberg, {Robert L.} and Ann Lambert and Kramer, {Michael S.} and Maria Carvalho and Agustin Conde-Agudelo and Jaffer, {Yasmin A.} and Enrico Bertino and Gravett, {Michael G.} and Altman, {Doug G.} and Ohuma, {Eric O.} and Manorama Purwar and Frederick, {Ihunnaya O.} and Bhutta, {Zulfiqar A.} and Kennedy, {Stephen H.} and Jos{\'e} Villar and M. Katz and Bhan, {M. K.} and C. Garza and S. Zaidi and A. Langer and Rothwell, {P. M.} and D. Weatherall and F. Burton and Chumlea, {W. C.} and P. Lumbiganon and J. Rivera and S. Kennedy and M. Shorten and L. Hoch and Knight, {H. E.} and C. Cosgrove and I. Blakey and F. Roseman and N. Kunnawar and Gu, {S. H.} and Wang, {J. H.} and M. Domingues and P. Gilli and L. Juodvirsiene and N. Musee and H. Al-Jabri and S. Waller and D. Muninzwa and D. Yellappan and A. Carter and D. Reade and R. Miller and L. Salomon and A. Leston and A. Mitidieri and F. Al-Aamri and W. Paulsene and J. Sande and Al-Zadjali, {W. K S} and C. Batiuk and S. Bornemeier and M. Dighe and P. Gaglioti and N. Jacinta and S. Jaiswal and K. Oas and M. Oberto and E. Olearo and Owende, {M. G.} and J. Shah and S. Sohoni and T. Todros and M. Venkataraman and S. Vinayak and L. Wang and D. Wilson and Wu, {Q. Q.} and P. Chamberlain and D. Danelon and I. Sarris and J. Dhami and C. Ioannou and Knight, {C. L.} and R. Napolitano and S. Wanyonyi and C. Pace and V. Mkrtychyan and {Cheikh Ismail}, L. and M. Alija and Jimenez-Bustos, {J. M.} and J. Kizidio and F. Puglia and H. Liu and S. Lloyd and D. Mota and R. Ochieng and C. Rossi and {Sanchez Luna}, M. and Shen, {Y. J.} and Rocco, {D. A.} and E. Albernaz and M. Batra and Bhat, {B. A.} and {Di Nicola}, P. and F. Giuliani and I. Rovelli and K. McCormick and V. Paul and V. Rajan and A. Wilkinson and A. Varalda and B. Eskenazi and Corra, {L. A.} and H. Dolk and J. Golding and A. Matijasevich and {De Wet}, T. and Zhang, {J. J.} and A. Bradman and D. Finkton and O. Burnham and F. Farhi and S. Fonseca and Sclowitz, {I. K.} and {Da Silveira}, {M. F.} and Pang, {R. Y.} and He, {Y. P.} and Y. Pan and Wu, {M. H.} and Y. Yuan and Y. Zhang and A. Choudhary and S. Choudhary and S. Deshmukh and D. Dongaonkar and M. Ketkar and V. Khedikar and C. Mahorkar and I. Mulik and K. Saboo and C. Shembekar and A. Singh and V. Taori and K. Tayade and A. Somani and M. Frigerio and G. Gilli and M. Giolito and L. Occhi and F. Signorile and M. Carvalho and W. Stones and C. Kisiangani and J. Al-Abri and J. Al-Abduwani and Al-Habsi, {F. M.} and H. Al-Lawatiya and B. Al-Rashidiya and Juangco, {F. R.} and Andersen, {H. F.} and Abbott, {S. E.} and Carter, {A. A.} and H. Algren and Sorensen, {T. K.} and D. Enquobahrie",
year = "2015",
month = "3",
day = "1",
doi = "10.1001/jamapediatrics.2014.3040",
language = "English (US)",
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pages = "220--229",
journal = "JAMA Pediatrics",
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TY - JOUR

T1 - The distribution of clinical phenotypes of preterm birth syndrome implications for prevention

AU - Barros, Fernando C.

AU - Papageorghiou, Aris T.

AU - Victora, Cesar G.

AU - Noble, Julia A.

AU - Pang, Ruyan

AU - Iams, Jay

AU - Ismail, Leila Cheikh

AU - Goldenberg, Robert L.

AU - Lambert, Ann

AU - Kramer, Michael S.

AU - Carvalho, Maria

AU - Conde-Agudelo, Agustin

AU - Jaffer, Yasmin A.

AU - Bertino, Enrico

AU - Gravett, Michael G.

AU - Altman, Doug G.

AU - Ohuma, Eric O.

AU - Purwar, Manorama

AU - Frederick, Ihunnaya O.

AU - Bhutta, Zulfiqar A.

AU - Kennedy, Stephen H.

AU - Villar, José

AU - Katz, M.

AU - Bhan, M. K.

AU - Garza, C.

AU - Zaidi, S.

AU - Langer, A.

AU - Rothwell, P. M.

AU - Weatherall, D.

AU - Burton, F.

AU - Chumlea, W. C.

AU - Lumbiganon, P.

AU - Rivera, J.

AU - Kennedy, S.

AU - Shorten, M.

AU - Hoch, L.

AU - Knight, H. E.

AU - Cosgrove, C.

AU - Blakey, I.

AU - Roseman, F.

AU - Kunnawar, N.

AU - Gu, S. H.

AU - Wang, J. H.

AU - Domingues, M.

AU - Gilli, P.

AU - Juodvirsiene, L.

AU - Musee, N.

AU - Al-Jabri, H.

AU - Waller, S.

AU - Muninzwa, D.

AU - Yellappan, D.

AU - Carter, A.

AU - Reade, D.

AU - Miller, R.

AU - Salomon, L.

AU - Leston, A.

AU - Mitidieri, A.

AU - Al-Aamri, F.

AU - Paulsene, W.

AU - Sande, J.

AU - Al-Zadjali, W. K S

AU - Batiuk, C.

AU - Bornemeier, S.

AU - Dighe, M.

AU - Gaglioti, P.

AU - Jacinta, N.

AU - Jaiswal, S.

AU - Oas, K.

AU - Oberto, M.

AU - Olearo, E.

AU - Owende, M. G.

AU - Shah, J.

AU - Sohoni, S.

AU - Todros, T.

AU - Venkataraman, M.

AU - Vinayak, S.

AU - Wang, L.

AU - Wilson, D.

AU - Wu, Q. Q.

AU - Chamberlain, P.

AU - Danelon, D.

AU - Sarris, I.

AU - Dhami, J.

AU - Ioannou, C.

AU - Knight, C. L.

AU - Napolitano, R.

AU - Wanyonyi, S.

AU - Pace, C.

AU - Mkrtychyan, V.

AU - Cheikh Ismail, L.

AU - Alija, M.

AU - Jimenez-Bustos, J. M.

AU - Kizidio, J.

AU - Puglia, F.

AU - Liu, H.

AU - Lloyd, S.

AU - Mota, D.

AU - Ochieng, R.

AU - Rossi, C.

AU - Sanchez Luna, M.

AU - Shen, Y. J.

AU - Rocco, D. A.

AU - Albernaz, E.

AU - Batra, M.

AU - Bhat, B. A.

AU - Di Nicola, P.

AU - Giuliani, F.

AU - Rovelli, I.

AU - McCormick, K.

AU - Paul, V.

AU - Rajan, V.

AU - Wilkinson, A.

AU - Varalda, A.

AU - Eskenazi, B.

AU - Corra, L. A.

AU - Dolk, H.

AU - Golding, J.

AU - Matijasevich, A.

AU - De Wet, T.

AU - Zhang, J. J.

AU - Bradman, A.

AU - Finkton, D.

AU - Burnham, O.

AU - Farhi, F.

AU - Fonseca, S.

AU - Sclowitz, I. K.

AU - Da Silveira, M. F.

AU - Pang, R. Y.

AU - He, Y. P.

AU - Pan, Y.

AU - Wu, M. H.

AU - Yuan, Y.

AU - Zhang, Y.

AU - Choudhary, A.

AU - Choudhary, S.

AU - Deshmukh, S.

AU - Dongaonkar, D.

AU - Ketkar, M.

AU - Khedikar, V.

AU - Mahorkar, C.

AU - Mulik, I.

AU - Saboo, K.

AU - Shembekar, C.

AU - Singh, A.

AU - Taori, V.

AU - Tayade, K.

AU - Somani, A.

AU - Frigerio, M.

AU - Gilli, G.

AU - Giolito, M.

AU - Occhi, L.

AU - Signorile, F.

AU - Carvalho, M.

AU - Stones, W.

AU - Kisiangani, C.

AU - Al-Abri, J.

AU - Al-Abduwani, J.

AU - Al-Habsi, F. M.

AU - Al-Lawatiya, H.

AU - Al-Rashidiya, B.

AU - Juangco, F. R.

AU - Andersen, H. F.

AU - Abbott, S. E.

AU - Carter, A. A.

AU - Algren, H.

AU - Sorensen, T. K.

AU - Enquobahrie, D.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Importance:Preterm birth has been difficult to study and prevent because of its complex syndromic nature.OBJECTIVE To identify phenotypes of preterm delivery syndrome in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Design, Setting, and Participants:A population-based, multiethnic, cross-sectional study conducted at 8 geographically demarcated sites in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States. A total of 60 058 births over a 12-month fixed period between April 27, 2009, and March 2, 2014. Of these, 53 871 had an ultrasonography estimate of gestational age, among which 5828 were preterm births (10.8%). Pregnancies were prospectively studied using a standardized data collection and online data management system. Newborns had anthropometric and clinical examinations using standardized methods and identical equipment and were followed up until hospital discharge.Main Outcomes and Measures: The main study outcomeswere clusters of preterm phenotypes and for each cluster, we analyzed signs of presentation at hospital admission, admission rates for neonatal intensive care for 7 days or more, and neonatal mortality rates.Results: Twelve preterm birth clusters were identified using our conceptual framework. Eleven consisted of combinations of conditions known to be associated with preterm birth, 10 of which were dominated by a single condition. However, themost common single cluster (30.0%of the total preterm cases; n = 1747) was not associated with any severe maternal, fetal, or placental condition that was clinically detectable based on the information available; within this cluster, many cases were caregiver initiated. Only 22%(n = 1284) of all the preterm births occurred spontaneously without any of these severe conditions. Maternal presentation on hospital admission, newborn anthropometry, and risk for death before hospital discharge or admission for 7 or more days to a neonatal intensive care unit, none of which were used to construct the clusters, also differed according to the identified phenotypes. The prevalence of preterm birth ranged from 8.2%in Muscat, Oman, and Oxford, England, to 16.6%in Seattle,Washington.Conclusions and Relevance: We identified 12 preterm birth phenotypes associated with different patterns of neonatal outcomes. In 22%of all preterm births, parturition started spontaneously and was not associated with any of the phenotypic conditions considered.We believe these results contribute to an improved understanding of this complex syndrome and provide an empirical basis to focus research on a more homogenous set of phenotypes.

AB - Importance:Preterm birth has been difficult to study and prevent because of its complex syndromic nature.OBJECTIVE To identify phenotypes of preterm delivery syndrome in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Design, Setting, and Participants:A population-based, multiethnic, cross-sectional study conducted at 8 geographically demarcated sites in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States. A total of 60 058 births over a 12-month fixed period between April 27, 2009, and March 2, 2014. Of these, 53 871 had an ultrasonography estimate of gestational age, among which 5828 were preterm births (10.8%). Pregnancies were prospectively studied using a standardized data collection and online data management system. Newborns had anthropometric and clinical examinations using standardized methods and identical equipment and were followed up until hospital discharge.Main Outcomes and Measures: The main study outcomeswere clusters of preterm phenotypes and for each cluster, we analyzed signs of presentation at hospital admission, admission rates for neonatal intensive care for 7 days or more, and neonatal mortality rates.Results: Twelve preterm birth clusters were identified using our conceptual framework. Eleven consisted of combinations of conditions known to be associated with preterm birth, 10 of which were dominated by a single condition. However, themost common single cluster (30.0%of the total preterm cases; n = 1747) was not associated with any severe maternal, fetal, or placental condition that was clinically detectable based on the information available; within this cluster, many cases were caregiver initiated. Only 22%(n = 1284) of all the preterm births occurred spontaneously without any of these severe conditions. Maternal presentation on hospital admission, newborn anthropometry, and risk for death before hospital discharge or admission for 7 or more days to a neonatal intensive care unit, none of which were used to construct the clusters, also differed according to the identified phenotypes. The prevalence of preterm birth ranged from 8.2%in Muscat, Oman, and Oxford, England, to 16.6%in Seattle,Washington.Conclusions and Relevance: We identified 12 preterm birth phenotypes associated with different patterns of neonatal outcomes. In 22%of all preterm births, parturition started spontaneously and was not associated with any of the phenotypic conditions considered.We believe these results contribute to an improved understanding of this complex syndrome and provide an empirical basis to focus research on a more homogenous set of phenotypes.

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UR - http://www.scopus.com/inward/citedby.url?scp=84924230892&partnerID=8YFLogxK

U2 - 10.1001/jamapediatrics.2014.3040

DO - 10.1001/jamapediatrics.2014.3040

M3 - Article

C2 - 25561016

AN - SCOPUS:84924230892

VL - 169

SP - 220

EP - 229

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 3

ER -