可存活婴儿的生存结局：一项比较不同收入国家和时间段的系统评价与荟萃分析。
Survival outcomes among periviable infants: a systematic review and meta-analysis comparing different income countries and time periods.
作者信息
Li Ying Xin, Hu Yan Ling, Huang Xi, Li Jie, Li Xia, Shi Ze Yao, Yang Ru, Zhang Xiujuan, Li Yuan, Chen Qiong
机构信息
Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
出版信息
Front Public Health. 2024 Dec 30;12:1454433. doi: 10.3389/fpubh.2024.1454433. eCollection 2024.
BACKGROUND
Periviable infants are a highly vulnerable neonatal group, and their survival rates are considerably affected by patient-, caregiver-, and institution-level factors, exhibiting wide variability across different income countries and time periods. This study aims to systematically review the literature on the survival rates of periviable infants and compare rates among countries with varied income levels and across different time periods.
METHODS
Comprehensive searches were conducted across MEDLINE, Embase, CENTRAL, and Web of Science. Cohort studies reporting survival outcomes by gestational age (GA) for periviable infants born between 22 + 0 and 25 + 6 weeks of gestation were considered. Paired reviewers independently extracted data and assessed the risk of bias and quality of evidence. Data pooling was achieved using random-effects meta-analyses.
RESULTS
Sixty-nine studies from 25 countries were included, covering 56,526 live births and 59,104 neonatal intensive care unit (NICU) admissions. Survival rates for infants born between 22 and 25 weeks of GA ranged from 7% (95% CI 5-10; 22 studies, = 5,658; low certainty) to 68% (95% CI 63-72; 35 studies, = 21,897; low certainty) when calculated using live births as the denominator, and from 30% (95% CI 25-36; 31 studies, = 3,991; very low certainty) to 74% (95% CI 70-77; 48 studies, = 17,664, very low certainty) for those admitted to NICUs. The survival rates improved over the two decades studied; however, stark contrasts were evident across countries with varying income levels.
CONCLUSION
Although the survival rates for periviable infants have improved over the past two decades, substantial disparities persist across different economic settings, highlighting global inequalities in perinatal health. Continued research and collaborative efforts are imperative to further improve the global survival and long-term outcomes of periviable infants, especially those in Low- and Middle-Income Countries.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42022376367, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022376367.
背景
可存活早产儿是一个高度脆弱的新生儿群体，其存活率受到患者、护理人员和机构层面因素的显著影响，在不同收入水平的国家和不同时期存在很大差异。本研究旨在系统回顾关于可存活早产儿存活率的文献，并比较不同收入水平国家和不同时期的存活率。
方法
对MEDLINE、Embase、CENTRAL和Web of Science进行全面检索。纳入报告妊娠22+0至25+6周出生的可存活早产儿按胎龄（GA）划分的生存结局的队列研究。两名审稿人独立提取数据并评估偏倚风险和证据质量。采用随机效应荟萃分析进行数据合并。
结果
纳入了来自25个国家的69项研究，涵盖56,526例活产和59,104例新生儿重症监护病房（NICU）入院病例。以活产为分母计算，22至25周GA出生婴儿的存活率范围为7%（95%CI 5-10；22项研究，n=5,658；低确定性）至68%（95%CI 63-72；35项研究，n=21,897；低确定性），而入住NICU的婴儿存活率范围为30%（95%CI 25-36；31项研究，n=3,991；极低确定性）至74%（95%CI 70-77；48项研究，n=17,664，极低确定性）。在所研究的二十年中，存活率有所提高；然而，不同收入水平的国家之间存在明显差异。
结论
尽管在过去二十年中，可存活早产儿的存活率有所提高，但在不同经济环境中仍存在巨大差距，凸显了围产期健康方面的全球不平等。继续开展研究和合作努力对于进一步提高可存活早产儿，尤其是低收入和中等收入国家可存活早产儿的全球存活率和长期结局至关重要。
系统评价注册
PROSPERO，CRD42022376367，可从以下网址获取：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022376367。
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