Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India.
Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
PLoS One. 2021 Aug 5;16(8):e0255352. doi: 10.1371/journal.pone.0255352. eCollection 2021.
Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied.
Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs.
CENTRAL, EMBASE, MEDLINE and Web of Science.
Prospective and retrospective observational studies were included.
Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE).
192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE-low) for ELBW and 39% (34% - 44%) (CoE-moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000-2009 and 2010-2020. Except for necrotising enterocolitis [ELBW and ELGANs-8% (7% - 10%)] and periventricular leukomalacia [ELBW-7% (4% - 11%); ELGANs-6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs.
CoE was very low to low for all secondary outcomes.
Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies.
PROSPERO (CRD42020222873).
发展中国家极低出生体重（ELBW）和极早早产儿（ELGANs）的发病率和死亡率尚未得到充分研究。
评估中低收入国家 ELBW 和 ELGANs 的存活率直至出院、短期和长期发病率。
CENTRAL、EMBASE、MEDLINE 和 Web of Science。
纳入前瞻性和回顾性观察性研究。
四位作者独立提取数据。使用比例的随机效应荟萃分析来综合数据，修改 QUIPS 量表评估研究质量，使用 GRADE 方法确定证据的确定性（CoE）。
纳入了 192 项研究，涉及 22278 名 ELBW 和 18338 名 ELGANs。ELBW 的存活率为 34%（95%CI：31%-37%）（CoE-低），ELGANs 的存活率为 39%（34%-44%）（CoE-中）。对于 ELBW 新生儿，低收入（LI）、中低收入（LMI）和中上收入（UMI）国家的存活率分别为 18%（11%-28%）、28%（21%-35%）和 39%（36%-42%）。对于 ELGANs，LI 国家的存活率为 13%（8%-20%），LMI 国家为 28%（21%-36%），UMI 国家为 48%（42%-53%）。两个时期（2000-2009 年和 2010-2020 年）之间的存活率没有差异。除坏死性小肠结肠炎[ELBW 和 ELGANs-8%（7%-10%）]和脑室周围白质软化[ELBW-7%（4%-11%）；ELGANs-6%（5%-7%）]外，其他所有发病率均高于发达国家。ELBW 新生儿的神经发育障碍发生率为 17%（7%-34%），ELGANs 为 29%（23%-37%）。
所有次要结局的 CoE 均为极低至低。
极低出生体重和极早早产儿在中低收入国家仍然是一个重大负担。所有次要结局的 CoE 均为极低至低，这强调了需要高质量的前瞻性队列研究。
PROSPERO（CRD42020222873）。
