Factors Associated With Neonatal Pneumonia and its Mortality in India: A Systematic Review and Meta-Analysis
N Sreekumaran Nair1, Leslie Edward Lewis2, Vijay Shree Dhyani1
1Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka.
Insights
Neonatal pneumonia is a major cause of infant death in India. This review found limited evidence on risk factors, with very low birth weight being a significant risk factor for incidence and alveolar-arterial oxygen gradient for mortality.
Area of Science:
- Neonatal Medicine
- Public Health
- Epidemiology
Background:
- Neonatal pneumonia significantly contributes to infant mortality in India and globally.
- Identifying risk factors is crucial for reducing infant deaths.
Purpose of the Study:
- To identify risk factors for neonatal pneumonia incidence and mortality in India.
- To systematically review existing literature on the topic.
Main Methods:
- Systematic review of analytic and descriptive studies.
- Searched multiple databases (CINAHL, EMBASE, MEDLINE, PubMed, etc.) from August to December 2016.
- Focused on studies conducted in India involving neonates.
Main Results:
- Eleven risk factors identified for neonatal pneumonia, including prematurity and very low birth weight.
- Very low birth weight (OR 5.61) significantly increased pneumonia incidence.
- Mean alveolar-arterial oxygen gradient >250 mm Hg was the primary mortality predictor.
Conclusions:
- Scant evidence exists in India regarding neonatal pneumonia risk factors beyond ventilator-associated pneumonia.
- Further research is needed to comprehensively understand and address neonatal pneumonia in India.
Background:
Neonatal pneumonia remains a significant contributor to infant mortality in India and responsible for increased prevalence of infant deaths globally.
Objective:
To identify risk factors associated with neonatal pneumonia and its mortality in India.
Study Design:
A systematic review was conducted including both analytic study designs and descriptive study designs, which reported a quantitative analysis of factors associated with all the three types of pneumonia among neonates. The search was conducted from August to December, 2016 on the following databases; CINAHL, EMBASE, Ovid MEDLINE, PubMed, ProQuest, SCOPUS, Web of Science, WHO IMSEAR and IndMED. The search was restricted to Indian setting.
Participants:
The population of interest was neonates.
Outcomes:
The outcome measures included risk factors for incidences and mortality predictors of neonatal pneumonia. These could be related to neonate, maternal and pregnancy, caregiver, family, environment, healthcare system, iatrogenic and others.
Results:
A total of three studies were included. For risk factors, two studies on ventilator-associated pneumonia were included with 194 neonates; whereas for mortality predictors, only one study with 150 neonates diagnosed with pneumonia was included. 11 risk factors were identified from two studies: duration of mechanical ventilation, postnatal age, birth weight, prematurity, sex of the neonate, length of stay in NICU, primary diagnosis, gestational age, number of re-intubation, birth asphyxia, and use of nasogastric tube. Meta-analysis with random-effects model was possible only for prematurity (<37 week) and very low birth weight (<1500 g) and very low birth weight was found to be significant (OR 5.61; 95% CI 1.76, 17.90). A single study was included on predictors of mortality. Mean alveolar arterial oxygen gradient (AaDO2) >250 mm Hg was found to be the single most significant predictor of mortality due to pneumonia in neonates.
Conclusion:
The study found scant evidence from India on risk factors of neonatal pneumonia other than ventilator-associated pneumonia.
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