Survival outcomes among periviable infants: a systematic review and meta-analysis comparing different income countries and time periods

Ying Xin Li; Yan Ling Hu; Xi Huang; Jie Li; Xia Li; Ze Yao Shi; Ru Yang; Xiujuan Zhang; Yuan Li; Qiong Chen

doi:10.3389/fpubh.2024.1454433

Survival outcomes among periviable infants: a systematic review and meta-analysis comparing different income countries and time periods

Front Public Health. 2024 Dec 30:12:1454433. doi: 10.3389/fpubh.2024.1454433. eCollection 2024.

Authors

Ying Xin Li^{1

2}, Yan Ling Hu^{1

2}, Xi Huang^{1

2}, Jie Li³, Xia Li^{1

2}, Ze Yao Shi^{1

2}, Ru Yang^{1

2}, Xiujuan Zhang^{1

2}, Yuan Li^{1

2}, Qiong Chen^{1

2}

Affiliations

¹ Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
² Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
³ West China School of Nursing, Sichuan University, Chengdu, China.

Abstract

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.

Keywords: extremely premature; infant; meta-analysis; survival; systematic review.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Developed Countries / statistics & numerical data
Developing Countries / statistics & numerical data
Female
Gestational Age*
Humans
Income / statistics & numerical data
Infant
Infant Mortality* / trends
Infant, Extremely Premature
Infant, Newborn
Intensive Care Units, Neonatal / statistics & numerical data
Pregnancy
Survival Rate

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Nursing Department of West China Second University Hospital [grant number HLBKJ202023]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.