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Meta-Analysis
. 2024 Mar 21;19(3):e0298519.
doi: 10.1371/journal.pone.0298519. eCollection 2024.

Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis

Beshada Zerfu Woldegeorgis  1 , Amanuel Yosef Gebrekidan  2 , Gizachew Ambaw Kassie  2 , Gedion Asnake Azeze  3 , Yordanos Sisay Asgedom  4 , Henok Berhanu Alemu  1 , Mohammed Suleiman Obsa  5
Affiliations
Meta-Analysis

Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis

Beshada Zerfu Woldegeorgis et al. PLoS One. .

Abstract

Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram for identification and selection of articles.
Fig 2
Fig 2. Forest plot for the pooled cumulative incidence of neonatal birth trauma.
Fig 3
Fig 3. Forest plot for subgroup analyses by region.
Fig 4
Fig 4. Forest plot for subgroup analyses by year of publication.
Fig 5
Fig 5. Funnel plot for publication bias.
Fig 6
Fig 6
(A) Counter-enhanced, and (B) the metric inverse counter-enhanced funnel plots of publication bias for the pooled cumulative incidence of neonatal birth trauma.
Fig 7
Fig 7. Regression graph of neonatal birth trauma.
Fig 8
Fig 8. Trim and fill analysis for the cumulative incidence of neonatal birth trauma.
Fig 9
Fig 9. The trend of neonatal birth trauma incidence in LMICs (1985 to 2023).
Fig 10
Fig 10. The patterns of neonatal birth trauma.
* others include visceral injuries (spleen, and liver).
See this image and copyright information in PMC

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