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Survival outcomes among periviable infants: a systematic review and meta-analysis comparing different income
Ying Xin Li1,2, Yan Ling Hu1,2, Xi Huang1,2
1Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
Insights
Survival rates for periviable infants have improved over two decades, but significant global disparities persist. Continued research is crucial to enhance outcomes, especially in low- and middle-income countries.
Area of Science:
- Neonatal Medicine
- Perinatal Health
- Global Health Equity
Background:
- Periviable infants represent a vulnerable neonatal population with survival rates influenced by patient, caregiver, and institutional factors.
- Significant variability exists in survival rates across different income countries and time periods.
- Understanding these disparities is critical for improving global neonatal care.
Purpose of the Study:
- To systematically review the literature on survival rates of periviable infants (22 to 25 weeks of gestation).
- To compare survival rates among countries with varied income levels.
- To analyze trends in survival rates across different time periods.
Main Methods:
- Comprehensive literature search across MEDLINE, Embase, CENTRAL, and Web of Science.
- Inclusion of cohort studies reporting survival outcomes for periviable infants.
- Independent data extraction, risk of bias assessment, and random-effects meta-analyses.
Main Results:
- Sixty-nine studies from 25 countries, including 56,526 live births and 59,104 NICU admissions, were analyzed.
- Survival rates varied widely, from 7% (based on live births) to 74% (based on NICU admissions) for infants born between 22 and 25 weeks gestation.
- Survival rates improved over two decades, but significant disparities were observed across countries with different income levels.
Conclusions:
- Despite improvements, substantial global inequalities in perinatal health persist for periviable infants.
- Economic setting significantly impacts survival rates, highlighting global health inequities.
- Further research and international collaboration are essential to improve global survival and long-term outcomes, particularly in low- and middle-income countries.
Background:
Periviable infants are a highly vulnerable neonatal group, and their survival rates are considerably affected by patient-, caregiver-, and institution-level factors, exhibiting wide variability across different income countries and time periods. This study aims to systematically review the literature on the survival rates of periviable infants and compare rates among countries with varied income levels and across different time periods.
Methods:
Comprehensive searches were conducted across MEDLINE, Embase, CENTRAL, and Web of Science. Cohort studies reporting survival outcomes by gestational age (GA) for periviable infants born between 22 + 0 and 25 + 6 weeks of gestation were considered. Paired reviewers independently extracted data and assessed the risk of bias and quality of evidence. Data pooling was achieved using random-effects meta-analyses.
Results:
Sixty-nine studies from 25 countries were included, covering 56,526 live births and 59,104 neonatal intensive care unit (NICU) admissions. Survival rates for infants born between 22 and 25 weeks of GA ranged from 7% (95% CI 5-10; 22 studies, n = 5,658; low certainty) to 68% (95% CI 63-72; 35 studies, n = 21,897; low certainty) when calculated using live births as the denominator, and from 30% (95% CI 25-36; 31 studies, n = 3,991; very low certainty) to 74% (95% CI 70-77; 48 studies, n = 17,664, very low certainty) for those admitted to NICUs. The survival rates improved over the two decades studied; however, stark contrasts were evident across countries with varying income levels.
Conclusion:
Although the survival rates for periviable infants have improved over the past two decades, substantial disparities persist across different economic settings, highlighting global inequalities in perinatal health. Continued research and collaborative efforts are imperative to further improve the global survival and long-term outcomes of periviable infants, especially those in Low- and Middle-Income Countries.
Systematic Review Registration:
PROSPERO, CRD42022376367, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022376367.
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