Sultana Saima, Horiuchi Sayaka, Homer Caroline Se, Baqui Abdullah H, Vogel Joshua P
Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia.
Burnet Institute, Women's, Children's and Adolescents' Health Program, Melbourne, Australia.
J Glob Health. 2025 Apr 4;15:04106. doi: 10.7189/jogh.15.04106.
Preterm birth is associated with an increased risk of adverse neurodevelopmental outcomes. However, prevalence estimates of adverse neurodevelopmental outcomes on preterm born children in low - and middle - income countries (LMICs) remain unclear. In this systematic review and meta-analysis, we aim to estimate the prevalence of adverse neurodevelopmental outcomes in preterm-born children in LMICs.
We comprehensively searched six electronic databases - Medline, Embase, CINAHL, PsycInfo, Scopus, and Web of Science, without language and date restrictions. We included observational studies conducted in LMICs that reported prevalence of any type of neurodevelopmental outcome in children born preterm using a validated method or clinical diagnosis, and outcome measurement was performed in at least 100 eligible children at age ≥12 months. The primary outcomes of interest were a composite of any neurodevelopmental impairment, cerebral palsy, visual impairment/blindness, hearing impairment/deafness, motor impairment, developmental delays, learning difficulties, and adverse behavioural and socio-emotional outcomes. We used the JBI critical appraisal checklist to assess the quality of the included studies, and prevalence estimates were calculated using a random-effects meta-analysis model.
A total of 47 data sets from 12 countries involving 72 974 preterm-born children were included. The estimated pooled prevalence of overall neurodevelopmental impairment and cerebral palsy was 16% (95% confidence interval (CI) = 11-21%) and 5% (95% CI = 3-6%), respectively. The pooled prevalence of developmental delays across different domains ranged from 8 to 13%. Lower prevalence was found in hearing impairment/deafness and visual impairment/blindness (1%). Higher prevalences were observed with decreasing gestational age and birth weight.
There is a high burden of adverse neurodevelopmental outcomes in preterm born children in LMICs. Such prevalence estimates are essential in informing clinical and public health policy, allocating scarce resources, and directing further research to improved outcomes in these settings.
PROSPERO: CRD42024569564.
早产与不良神经发育结局风险增加相关。然而，低收入和中等收入国家（LMICs）早产儿童不良神经发育结局的患病率估计仍不明确。在这项系统评价和荟萃分析中，我们旨在估计LMICs早产儿童不良神经发育结局的患病率。
我们全面检索了六个电子数据库——Medline、Embase、CINAHL、PsycInfo、Scopus和Web of Science，无语言和日期限制。我们纳入了在LMICs进行的观察性研究，这些研究报告了使用经过验证的方法或临床诊断得出的早产儿童任何类型神经发育结局的患病率，并且在至少100名年龄≥12个月的符合条件儿童中进行了结局测量。感兴趣的主要结局是任何神经发育障碍、脑瘫、视力障碍/失明、听力障碍/失聪、运动障碍、发育迟缓、学习困难以及不良行为和社会情感结局的综合。我们使用JBI批判性评价清单评估纳入研究的质量，并使用随机效应荟萃分析模型计算患病率估计值。
共纳入了来自12个国家的47个数据集，涉及72974名早产儿童。总体神经发育障碍和脑瘫的估计合并患病率分别为16%（95%置信区间（CI）=11 - 21%）和5%（95%CI = 3 - 6%）。不同领域发育迟缓的合并患病率在8%至13%之间。听力障碍/失聪和视力障碍/失明的患病率较低（1%）。随着胎龄和出生体重的降低，患病率更高。
LMICs早产儿童不良神经发育结局的负担很高。此类患病率估计对于为临床和公共卫生政策提供信息、分配稀缺资源以及指导进一步研究以改善这些情况下的结局至关重要。
PROSPERO：CRD42024569564
