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Meta-Analysis
. 2021 Aug 5;16(8):e0255352.
doi: 10.1371/journal.pone.0255352. eCollection 2021.

ELBW and ELGAN outcomes in developing nations-Systematic review and meta-analysis

Viraraghavan Vadakkencherry Ramaswamy  1 , Thangaraj Abiramalatha  2 , Tapas Bandyopadhyay  3 , Nasreen Banu Shaik  1 , Prathik Bandiya  4 , Debasish Nanda  5 , Abdul Kareem Pullattayil S  6 , Srinivas Murki  7 , Charles Christoph Roehr  8   9   10
Affiliations
Meta-Analysis

ELBW and ELGAN outcomes in developing nations-Systematic review and meta-analysis

Viraraghavan Vadakkencherry Ramaswamy et al. PLoS One. .

Abstract

Context: Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied.

Objectives: Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs.

Data sources: CENTRAL, EMBASE, MEDLINE and Web of Science.

Study selection: Prospective and retrospective observational studies were included.

Data extraction and synthesis: Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE).

Results: 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE-low) for ELBW and 39% (34% - 44%) (CoE-moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000-2009 and 2010-2020. Except for necrotising enterocolitis [ELBW and ELGANs-8% (7% - 10%)] and periventricular leukomalacia [ELBW-7% (4% - 11%); ELGANs-6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs.

Limitations: CoE was very low to low for all secondary outcomes.

Conclusions: Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies.

Trial registration: PROSPERO (CRD42020222873).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow.
Fig 2
Fig 2. Survival until discharge for ELBW neonates based on country of origin.
Fig 3
Fig 3. Survival until discharge for ELGANs based on country of origin.
See this image and copyright information in PMC

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