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Review
. 2013 Dec;74 Suppl 1(Suppl 1):17-34.
doi: 10.1038/pr.2013.204.

Preterm birth-associated neurodevelopmental impairment estimates at regional and global levels for 2010

Hannah Blencowe  1 , Anne C C Lee  2 , Simon Cousens  1 , Adil Bahalim  3 , Rajesh Narwal  4 , Nanbert Zhong  5 , Doris Chou  6 , Lale Say  6 , Neena Modi  7 , Joanne Katz  8 , Theo Vos  9 , Neil Marlow  10 , Joy E Lawn  11
Affiliations
Free PMC article
Review

Preterm birth-associated neurodevelopmental impairment estimates at regional and global levels for 2010

Hannah Blencowe et al. Pediatr Res. 2013 Dec.
Free PMC article

Abstract

Background: In 2010, there were an estimated 15 million preterm births worldwide (<37 wk gestation). Survivors are at risk of adverse outcomes, and burden estimation at global and regional levels is critical for priority setting.

Methods: Systematic reviews and meta-analyses were undertaken to estimate the risk of long-term neurodevelopmental impairment for surviving preterm babies according to the level of care. A compartmental model was used to estimate the number of impaired postneonatal survivors following preterm birth in 2010. A separate model (DisMod-MR) was used to estimate years lived with disability (YLDs) for the global burden of disease 2010 study. Disability adjusted life years (DALYs) were calculated as the sum of YLDs and years of life lost (YLLs).

Results: In 2010, there were an estimated 13 million preterm births who survived beyond the first month. Of these, 345,000 (2.7%, uncertainty range: 269,000-420,000) were estimated to have moderate or severe neurodevelopmental impairment, and a further 567,000 (4.4%, (445,000-732,000)) were estimated to have mild neurodevelopmental impairment. Many more have specific learning or behavioral impairments or reduced physical or mental health. Fewest data are available where the burden is heaviest. Preterm birth was responsible for 77 million DALYs, 3.1% of the global total, of which only 3 million were YLDs.

Conclusion: Most preterm births (>90%) survive without neurodevelopmental impairment. Developing effective means of prevention of preterm birth should be a longer term priority, but major burden reduction could be made immediately with improved coverage and quality of care. Improved newborn care would reduce mortality, especially in low-income countries and is likely to reduce impairment in survivors, particularly in middle-income settings.

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Figures

Figure 1
Figure 1
Disease schema for sequelae of preterm birth.
Figure 2
Figure 2
Compartmental model: Parameters required and methods for estimation of the global burden of impairment related to preterm birth for the estimation of impairment after preterm birth.
Figure 3
Figure 3
Number of preterm births in 2010 for world region according to the sex of the baby. Males are shown in dark gray, females in light gray.
Figure 4
Figure 4
Meta-analysis of studies reporting moderate/severe impairment outcomes for babies born at less than 28 wk in countries with neonatal mortality rate (NMR) <5 in 2000–2010.
Figure 5
Figure 5
Meta-analysis of studies reporting moderate/severe impairment outcomes for babies born at 28–31 wk in countries with neonatal mortality rate (NMR) <5 in 2000–2010.
Figure 6
Figure 6
Meta-analysis of studies reporting moderate/severe impairment outcomes for babies born at less than 32 wk in countries with neonatal mortality rate (NMR) ≥5 in 2000–2010.
Figure 7
Figure 7
Worldwide deaths and disability for babies born preterm in 2010.
Figure 8
Figure 8
Regional burden of mortality and impairment for 15 million preterm babies born in 2010.
See this image and copyright information in PMC

References

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