与印度新生儿肺炎及其死亡率相关的因素：系统评价和荟萃分析。

Factors Associated With Neonatal Pneumonia and its Mortality in India: A Systematic Review and Meta-Analysis.

机构信息

Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka.

Department of Pediatrics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, Karnataka.

出版信息

Indian Pediatr. 2021 Nov 15;58(11):1059-1061. doi: 10.1007/s13312-021-2374-4.

DOI:10.1007/s13312-021-2374-4

PMID:34837367

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8639407/

Abstract

BACKGROUND

Neonatal pneumonia remains a significant contributor to infant mortality in India and responsible for increased prevalence of infant deaths globally.

OBJECTIVE

To identify risk factors associated with neonatal pneumonia and its mortality in India.

STUDY DESIGN

A systematic review was conducted including both analytic study designs and descriptive study designs, which reported a quantitative analysis of factors associated with all the three types of pneumonia among neonates. The search was conducted from August to December, 2016 on the following databases; CINAHL, EMBASE, Ovid MEDLINE, PubMed, ProQuest, SCOPUS, Web of Science, WHO IMSEAR and IndMED. The search was restricted to Indian setting.

PARTICIPANTS

The population of interest was neonates.

OUTCOMES

The outcome measures included risk factors for incidences and mortality predictors of neonatal pneumonia. These could be related to neonate, maternal and pregnancy, caregiver, family, environment, healthcare system, iatrogenic and others.

RESULTS

A total of three studies were included. For risk factors, two studies on ventilator-associated pneumonia were included with 194 neonates; whereas for mortality predictors, only one study with 150 neonates diagnosed with pneumonia was included. 11 risk factors were identified from two studies: duration of mechanical ventilation, postnatal age, birth weight, prematurity, sex of the neonate, length of stay in NICU, primary diagnosis, gestational age, number of re-intubation, birth asphyxia, and use of nasogastric tube. Meta-analysis with random-effects model was possible only for prematurity (<37 week) and very low birth weight (<1500 g) and very low birth weight was found to be significant (OR 5.61; 95% CI 1.76, 17.90). A single study was included on predictors of mortality. Mean alveolar arterial oxygen gradient (AaDO2) >250 mm Hg was found to be the single most significant predictor of mortality due to pneumonia in neonates.

CONCLUSION

The study found scant evidence from India on risk factors of neonatal pneumonia other than ventilator-associated pneumonia.

摘要

背景

新生儿肺炎仍然是印度婴儿死亡的主要原因，也是全球婴儿死亡人数增加的原因。

目的

确定与印度新生儿肺炎及其死亡率相关的危险因素。

研究设计

系统评价包括分析性研究设计和描述性研究设计，报告了与三种类型的新生儿肺炎相关的所有因素的定量分析。该搜索于 2016 年 8 月至 12 月在以下数据库中进行：CINAHL、EMBASE、Ovid MEDLINE、PubMed、ProQuest、SCOPUS、Web of Science、WHO IMSEAR 和 IndMED。搜索仅限于印度环境。

参与者

感兴趣的人群是新生儿。

结果

结局指标包括新生儿肺炎发生率的危险因素和死亡率预测因素。这些因素可能与新生儿、产妇和妊娠、护理人员、家庭、环境、医疗保健系统、医源性和其他因素有关。

结果

共纳入三项研究。对于危险因素，纳入了两项呼吸机相关性肺炎研究，共纳入 194 名新生儿；而对于死亡率预测因素，仅纳入了一项纳入 150 名诊断为肺炎的新生儿的研究。从两项研究中确定了 11 个危险因素：机械通气时间、出生后年龄、出生体重、早产、新生儿性别、新生儿重症监护病房住院时间、主要诊断、胎龄、再次插管次数、出生窒息和使用鼻胃管。仅对早产儿（<37 周）和极低出生体重儿（<1500 克）进行了随机效应模型的荟萃分析，发现极低出生体重儿具有统计学意义（OR 5.61；95%CI 1.76,17.90）。仅纳入了一项关于死亡率预测因素的研究。发现肺泡动脉氧分压差（AaDO2）>250 mm Hg 是新生儿肺炎死亡的唯一最重要的预测因素。