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Rates of bronchopulmonary dysplasia in very low birth weight neonates: a systematic review and meta-analysis
Alvaro Moreira1, Michelle Noronha2, Jooby Joy3
1Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229-3900, USA. MoreiraA@uthscsa.edu.
Insights
This study estimates bronchopulmonary dysplasia (BPD) prevalence in premature infants. The global prevalence was 35% for BPD at 28 days and 21% at 36 weeks postmenstrual age.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Public Health
Background:
- Bronchopulmonary dysplasia (BPD) is a significant concern for premature infants, necessitating accurate prevalence data for effective prevention and treatment strategies.
- Current systematic approaches to ascertain BPD rates are lacking, highlighting the need for large-scale estimations.
Approach:
- A comprehensive systematic review and meta-analysis was conducted, searching MEDLINE from 1990 to 2019.
- Included were randomized controlled trials and observational studies defining BPD by oxygen requirement at 28 days (BPD28) or 36 weeks postmenstrual age (BPD36).
- Random-effects meta-analysis pooled data from 105 articles (780,936 patients), with subgroup and sensitivity analyses performed to address heterogeneity.
Key Points:
- The pooled prevalence of BPD was 35% (BPD28) and 21% (BPD36) across the included studies.
- Subgroup analyses revealed that birth weight, gestational age, and continent significantly influenced BPD prevalence.
- These findings provide crucial global estimates for BPD in very low birth weight and/or very low gestational age neonates.
Conclusions:
- This systematic review and meta-analysis offers a robust global estimation of BPD prevalence in vulnerable neonatal populations.
- The identified prevalence rates underscore the ongoing challenge of BPD and inform public health initiatives.
- Understanding the drivers of BPD prevalence is essential for targeted interventions and improved outcomes in neonates.
Importance:
Large-scale estimates of bronchopulmonary dysplasia (BPD) are warranted for adequate prevention and treatment. However, systematic approaches to ascertain rates of BPD are lacking.
Objective:
To conduct a systematic review and meta-analysis to assess the prevalence of BPD in very low birth weight (≤ 1,500 g) or very low gestational age (< 32 weeks) neonates.
Data Sources:
A search of MEDLINE from January 1990 until September 2019 using search terms related to BPD and prevalence was performed.
Study Selection:
Randomized controlled trials and observational studies evaluating rates of BPD in very low birth weight or very low gestational age infants were eligible. Included studies defined BPD as positive pressure ventilation or oxygen requirement at 28 days (BPD28) or at 36 weeks postmenstrual age (BPD36).
Data Extraction And Synthesis:
Two reviewers independently conducted all stages of the review. Random-effects meta-analysis was used to calculate the pooled prevalence. Subgroup analyses included gestational age group, birth weight group, setting, study period, continent, and gross domestic product. Sensitivity analyses were performed to reduce study heterogeneity.
Main Outcomes And Measures:
Prevalence of BPD defined as BPD28, BPD36, and by subgroups.
Results:
A total of 105 articles or databases and 780,936 patients were included in this review. The pooled prevalence was 35% (95% CI, 28-42%) for BPD28 (n = 26 datasets, 132,247 neonates), and 21% (95% CI, 19-24%) for BPD36 (n = 70 studies, 672,769 neonates). In subgroup meta-analyses, birth weight category, gestational age category, and continent were strong drivers of the pooled prevalence of BPD.
Conclusions And Relevance:
This study provides a global estimation of BPD prevalence in very low birth weight/low gestation neonates.
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