Global inequities in the survival of extremely preterm infants: a systematic review and meta-analysis.

Getaneh, T; Homaira, N; Kasaye, H; Tapawan, SJC; Chughtai, AA; Lui, K

Global inequities in the survival of extremely preterm infants: a systematic review and meta-analysis.

Getaneh, T Homaira, N Kasaye, H

Tapawan, SJC Chughtai, AA Lui, K

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Publisher:: Springer Nature
Publication Type:: Journal Article
Citation:: BMC Pediatr, 2025, 25, (1), pp. 579
Issue Date:: 2025-07-30

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Field	Value	Language
dc.contributor.author	Getaneh, T
dc.contributor.author	Homaira, N
dc.contributor.author	Kasaye, H https://orcid.org/0000-0003-3759-2604
dc.contributor.author	Tapawan, SJC
dc.contributor.author	Chughtai, AA
dc.contributor.author	Lui, K
dc.date.accessioned	2025-09-03T07:51:04Z
dc.date.available	2025-07-07
dc.date.available	2025-09-03T07:51:04Z
dc.date.issued	2025-07-30
dc.identifier.citation	BMC Pediatr, 2025, 25, (1), pp. 579
dc.identifier.issn	1471-2431
dc.identifier.issn	1471-2431
dc.identifier.uri	http://hdl.handle.net/10453/189601
dc.description.abstract	BACKGROUND: Despite the associated major morbidities, advances in neonatal care units have improved the survival rates of extremely preterm infants. However, the varying survival rates make it challenging to set policy decisions around the standardization of care. Therefore, this study aimed to determine the global survival rate of extremely preterm infants and to compare it across different income levels and over time during the last two decades. METHOD: A comprehensive systematic search was conducted across major databases, including PubMed/Medline, EMBASE, CINAHL, Web of Science, Scopus, AJOL, Google Scholar and Google, to identify relevant articles. All peer-reviewed studies reported the survival rate of extremely preterm infants (born before 29 weeks' gestation) between January 1st, 2000, and June 25th, 2024, were included. Outcomes were compared between Epoch 1 (2000-2015, Millennium Developmental Goals period) and Epoch 2 (2016-2024, Sustainable Developmental Goals period). DerSimonian‒Laird random effects model was fitted to estimate the pooled weighted outcomes. RESULTS: A total of 217 studies involving 917,176 infants were included. Based on published data, 61.4% (95% CI: 58.13-64.81) of extremely preterm infants survived to discharge, and 51.7% (95% CI: 44.25-59.22) of survivors were discharged without major morbidity. Survival rate was significantly lower in low- and middle-income countries (44.3%) compared to high-income countries (69.3%). Among low- and middle-income countries, survival improved from 38% during the epoch 1 to 44.8% during the epoch 2. While in high-income countries it was 69.9% during epoch 1 and 64.2% during epoch 2. These findings are based on reported literature; may not fully reflect outcomes in low-resource settings where data are limited and underreported. Variability in the inclusion and care of borderline viable infants also contributes to the heterogeneity and uncertainty of the estimates. CONCLUSION: Survival of extremely preterm infants varies widely across settings, with fewer than half surviving in low- and middle-income countries. While some improvement was observed in these regions during the Sustainable Developmental Goals period, comparisons across epochs and regions should be interpreted cautiously due to differences in data availability and population characteristics. These variations underscore the need for context-specific strategies that balance available resources, cultural values, and ethical considerations. Further population-level data, particularly from low-and middle-income countries, are essential to inform equitable global neonatal care policies. REGISTRATION: PROSPERO (CDR42023447612 (PROSPERO (york.ac.uk)). CLINICAL TRIAL NUMBER: Not applicable.
dc.format	Electronic
dc.language	eng
dc.publisher	Springer Nature
dc.relation.ispartof	BMC Pediatr
dc.relation.isbasedon	10.1186/s12887-025-05933-w
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1114 Paediatrics and Reproductive Medicine
dc.subject.classification	Pediatrics
dc.subject.classification	3213 Paediatrics
dc.subject.classification	4204 Midwifery
dc.subject.mesh	Humans
dc.subject.mesh	Infant, Extremely Premature
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Global Health
dc.subject.mesh	Infant Mortality
dc.subject.mesh	Survival Rate
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Developed Countries
dc.subject.mesh	Developing Countries
dc.subject.mesh	Infant
dc.subject.mesh	Humans
dc.subject.mesh	Infant Mortality
dc.subject.mesh	Survival Rate
dc.subject.mesh	Developed Countries
dc.subject.mesh	Developing Countries
dc.subject.mesh	Infant
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Infant, Extremely Premature
dc.subject.mesh	Global Health
dc.subject.mesh	Humans
dc.subject.mesh	Infant, Extremely Premature
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Global Health
dc.subject.mesh	Infant Mortality
dc.subject.mesh	Survival Rate
dc.subject.mesh	Healthcare Disparities
dc.subject.mesh	Developed Countries
dc.subject.mesh	Developing Countries
dc.subject.mesh	Infant
dc.title	Global inequities in the survival of extremely preterm infants: a systematic review and meta-analysis.
dc.type	Journal Article
utslib.citation.volume	25
utslib.location.activity	England
utslib.for	1114 Paediatrics and Reproductive Medicine
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.date.updated	2025-09-03T07:51:01Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	25
utslib.citation.issue	1

Abstract:

BACKGROUND: Despite the associated major morbidities, advances in neonatal care units have improved the survival rates of extremely preterm infants. However, the varying survival rates make it challenging to set policy decisions around the standardization of care. Therefore, this study aimed to determine the global survival rate of extremely preterm infants and to compare it across different income levels and over time during the last two decades. METHOD: A comprehensive systematic search was conducted across major databases, including PubMed/Medline, EMBASE, CINAHL, Web of Science, Scopus, AJOL, Google Scholar and Google, to identify relevant articles. All peer-reviewed studies reported the survival rate of extremely preterm infants (born before 29 weeks' gestation) between January 1st, 2000, and June 25th, 2024, were included. Outcomes were compared between Epoch 1 (2000-2015, Millennium Developmental Goals period) and Epoch 2 (2016-2024, Sustainable Developmental Goals period). DerSimonian‒Laird random effects model was fitted to estimate the pooled weighted outcomes. RESULTS: A total of 217 studies involving 917,176 infants were included. Based on published data, 61.4% (95% CI: 58.13-64.81) of extremely preterm infants survived to discharge, and 51.7% (95% CI: 44.25-59.22) of survivors were discharged without major morbidity. Survival rate was significantly lower in low- and middle-income countries (44.3%) compared to high-income countries (69.3%). Among low- and middle-income countries, survival improved from 38% during the epoch 1 to 44.8% during the epoch 2. While in high-income countries it was 69.9% during epoch 1 and 64.2% during epoch 2. These findings are based on reported literature; may not fully reflect outcomes in low-resource settings where data are limited and underreported. Variability in the inclusion and care of borderline viable infants also contributes to the heterogeneity and uncertainty of the estimates. CONCLUSION: Survival of extremely preterm infants varies widely across settings, with fewer than half surviving in low- and middle-income countries. While some improvement was observed in these regions during the Sustainable Developmental Goals period, comparisons across epochs and regions should be interpreted cautiously due to differences in data availability and population characteristics. These variations underscore the need for context-specific strategies that balance available resources, cultural values, and ethical considerations. Further population-level data, particularly from low-and middle-income countries, are essential to inform equitable global neonatal care policies. REGISTRATION: PROSPERO (CDR42023447612 (PROSPERO (york.ac.uk)). CLINICAL TRIAL NUMBER: Not applicable.

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