Getaneh Temesgen, Homaira Nusrat, Kasaye Habtamu, Tapawan Sarah Jane C, Chughtai Abrar Ahmad, Lui Kei
College of Health Science, Midwifery Department, Debre Markos University, Debre Markos University, Debre Markos, Ethiopia.
Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW, Sydney, Australia.
BMC Pediatr. 2025 Jul 30;25(1):579. doi: 10.1186/s12887-025-05933-w.
Despite the associated major morbidities, advances in neonatal care units have improved the survival rates of extremely preterm infants. However, the varying survival rates make it challenging to set policy decisions around the standardization of care. Therefore, this study aimed to determine the global survival rate of extremely preterm infants and to compare it across different income levels and over time during the last two decades.
A comprehensive systematic search was conducted across major databases, including PubMed/Medline, EMBASE, CINAHL, Web of Science, Scopus, AJOL, Google Scholar and Google, to identify relevant articles. All peer-reviewed studies reported the survival rate of extremely preterm infants (born before 29 weeks' gestation) between January 1 2000, and June 25th, 2024, were included. Outcomes were compared between Epoch 1 (2000-2015, Millennium Developmental Goals period) and Epoch 2 (2016-2024, Sustainable Developmental Goals period). DerSimonian‒Laird random effects model was fitted to estimate the pooled weighted outcomes.
A total of 217 studies involving 917,176 infants were included. Based on published data, 61.4% (95% CI: 58.13-64.81) of extremely preterm infants survived to discharge, and 51.7% (95% CI: 44.25-59.22) of survivors were discharged without major morbidity. Survival rate was significantly lower in low- and middle-income countries (44.3%) compared to high-income countries (69.3%). Among low- and middle-income countries, survival improved from 38% during the epoch 1 to 44.8% during the epoch 2. While in high-income countries it was 69.9% during epoch 1 and 64.2% during epoch 2. These findings are based on reported literature; may not fully reflect outcomes in low-resource settings where data are limited and underreported. Variability in the inclusion and care of borderline viable infants also contributes to the heterogeneity and uncertainty of the estimates.
Survival of extremely preterm infants varies widely across settings, with fewer than half surviving in low- and middle-income countries. While some improvement was observed in these regions during the Sustainable Developmental Goals period, comparisons across epochs and regions should be interpreted cautiously due to differences in data availability and population characteristics. These variations underscore the need for context-specific strategies that balance available resources, cultural values, and ethical considerations. Further population-level data, particularly from low-and middle-income countries, are essential to inform equitable global neonatal care policies.
PROSPERO (CDR42023447612 (PROSPERO (york.ac.uk)).
Not applicable.
尽管存在相关的重大疾病，但新生儿重症监护病房的进步提高了极早产儿的存活率。然而，不同的存活率使得围绕护理标准化制定政策决策具有挑战性。因此，本研究旨在确定极早产儿的全球存活率，并在过去二十年中跨不同收入水平和不同时间进行比较。
在包括PubMed/Medline、EMBASE、CINAHL、Web of Science、Scopus、AJOL、谷歌学术和谷歌在内的主要数据库中进行了全面的系统检索，以识别相关文章。纳入所有在2000年1月1日至2024年6月25日期间报告极早产儿（妊娠29周前出生）存活率的同行评审研究。比较了第1阶段（2000 - 2015年，千年发展目标时期）和第2阶段（2016 - 2024年，可持续发展目标时期）的结果。采用DerSimonian-Laird随机效应模型来估计合并加权结果。
共纳入217项涉及917,176名婴儿的研究。根据已发表的数据，61.4%（95%可信区间：58.13 - 64.81）的极早产儿存活至出院，51.7%（95%可信区间：44.25 - 59.22）的存活者出院时无重大疾病。低收入和中等收入国家的存活率（44.3%）显著低于高收入国家（69.3%）。在低收入和中等收入国家中，存活率从第1阶段的38%提高到第2阶段的44.8%。而在高收入国家，第1阶段为69.9%，第2阶段为64.2%。这些发现基于已报告的文献；可能无法完全反映资源有限且数据报告不足的低资源环境中的结果。临界存活婴儿纳入和护理的差异也导致了估计的异质性和不确定性。
极早产儿的存活率在不同环境中差异很大，在低收入和中等收入国家中存活者不到一半。虽然在可持续发展目标时期这些地区有一些改善，但由于数据可用性和人群特征的差异，跨时期和地区的比较应谨慎解释。这些差异凸显了制定因地制宜策略的必要性，这些策略要平衡可用资源、文化价值观和伦理考量。进一步的人群水平数据，特别是来自低收入和中等收入国家的数据，对于制定公平的全球新生儿护理政策至关重要。
PROSPERO（CDR42023447612（PROSPERO（york.ac.uk））。
不适用。
