Jiang Li, Lee Him Rachel, Sihota Davneet, Muralidharan Oviya, Dominguez Georgia, Harrison Leila, Vaivada Tyler, Bhutta Zulfiqar A
Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
Neonatology. 2025;122(Suppl 1):129-151. doi: 10.1159/000541872. Epub 2024 Nov 21.
Small vulnerable newborns (SVNs) are at an increased risk of early death and other morbidities. Essential interventions provided to SVN, and other high-risk newborns have been proven critical in improving their outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Following a comprehensive literature scope, we updated or reanalyzed LMIC-specific evidence for essential SVN care interventions.
A total of 113 individual LMIC studies were identified. Most of them were of high risk of bias. Kangaroo mother care significantly reduced SVN's mortality by discharge. Early erythropoiesis stimulating agent lowered SVN's risk of receiving blood transfusion. Prophylactic oral or intravenous ibuprofen resulted in a decreased risk of patent ductus arteriosus in SVN. But it did not have a significant effect on mortality and led to a higher risk of gastrointestinal bleeding. No pooled LMIC data were available for universal screening of hyperbilirubinemia in high-risk newborns. Sunlight therapy had no effect in treating hyperbilirubinemia but increased the risk of hyperthermia. Reflective curtains with phototherapy resulted in a greater and faster decline in bilirubin than standard phototherapy in treating hyperbilirubinemia. Early child development interventions were shown to have a favorable effect on cognitive and motor scores in SVN. The evidence for family involvement and family support was limited and uncertain.
We present the most updated LMIC evidence for interventions targeting SVN. Despite their effectiveness and safety in improving certain neonatal outcomes, further high-quality trials are required.
脆弱的低体重新生儿（SVN）早期死亡和其他疾病的风险增加。已证明，为SVN及其他高危新生儿提供的基本干预措施对于改善其预后至关重要。我们旨在更新这些干预措施在低收入和中等收入国家（LMIC）的有效性和安全性。
在全面界定文献范围后，我们更新或重新分析了针对SVN基本护理干预措施的特定LMIC证据。
共确定了113项LMIC的个体研究。其中大多数存在高偏倚风险。袋鼠式护理显著降低了SVN出院时的死亡率。早期促红细胞生成素可降低SVN接受输血的风险。预防性口服或静脉注射布洛芬可降低SVN动脉导管未闭的风险。但它对死亡率没有显著影响，且导致胃肠道出血风险更高。没有汇总的LMIC数据可用于对高危新生儿进行普遍的高胆红素血症筛查。日光疗法对治疗高胆红素血症无效，但会增加体温过高的风险。在治疗高胆红素血症方面，带光疗的反光窗帘比标准光疗能使胆红素下降得更大且更快。早期儿童发育干预措施对SVN的认知和运动评分有积极影响。关于家庭参与和家庭支持的证据有限且不确定。
我们提供了针对SVN干预措施的最新LMIC证据。尽管它们在改善某些新生儿结局方面具有有效性和安全性，但仍需要进一步的高质量试验。
