{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:44:50Z","timestamp":1792482290690,"version":"4.5.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Context<\/jats:title>\n Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs.<\/jats:p>\n <\/jats:sec>\n \n Data sources<\/jats:title>\n CENTRAL, EMBASE, MEDLINE and Web of Science.<\/jats:p>\n <\/jats:sec>\n \n Study selection<\/jats:title>\n Prospective and retrospective observational studies were included.<\/jats:p>\n <\/jats:sec>\n \n Data extraction and synthesis<\/jats:title>\n Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE\u2013low) for ELBW and 39% (34% - 44%) (CoE\u2014moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000\u20132009 and 2010\u20132020. Except for necrotising enterocolitis [ELBW and ELGANs\u20148% (7% - 10%)] and periventricular leukomalacia [ELBW\u20147% (4% - 11%); ELGANs\u20146% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n CoE was very low to low for all secondary outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n PROSPERO (\n CRD42020222873<\/jats:ext-link>\n ).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0255352","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T18:10:57Z","timestamp":1628187057000},"page":"e0255352","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":65,"title":["ELBW and ELGAN outcomes in developing nations\u2013Systematic review and meta-analysis"],"prefix":"10.1371","volume":"16","author":[{"given":"Viraraghavan Vadakkencherry","family":"Ramaswamy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thangaraj","family":"Abiramalatha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6872-0942","authenticated-orcid":true,"given":"Tapas","family":"Bandyopadhyay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasreen Banu","family":"Shaik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prathik","family":"Bandiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debasish","family":"Nanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6718-5228","authenticated-orcid":true,"given":"Abdul Kareem","family":"Pullattayil S.","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas","family":"Murki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Christoph","family":"Roehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"issue":"1","key":"pone.0255352.ref001","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/ijgo.13195","article-title":"Global burden of preterm birth.","volume":"150","author":"SR Walani","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0255352.ref002","unstructured":"WHO, March of Dimes, PMNCH, Save the Children. 15 million preterm births: Priorities for action based on national, regional and global estimates. In: Howson CP, Kinney MV, Lawn J, eds. Born Too Soon: The Global Action Report on Preterm Birth. 2012."},{"key":"pone.0255352.ref003","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/S2214-109X(18)30451-0","article-title":"Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis","volume":"7","author":"S Chawanpaiboon","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pone.0255352.ref004","first-page":"2162","article-title":"National, regional and worldwide estimates of preterm birth","volume":"379","author":"H Blencowe","year":"2012","journal-title":"Lancet"},{"key":"pone.0255352.ref005","unstructured":"WHO, Every Newborn: an action plan to end preventable deaths. 2014 https:\/\/www.who.int\/maternal_child_adolescent\/documents\/every-newborn-action-plan\/en\/ Accessed 10th January 2021."},{"key":"pone.0255352.ref006","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(05)71048-5","article-title":"Neonatal survival 1\u20134 million neonatal deaths: When? Where? Why?","volume":"365","author":"JE Lawn","year":"2005","journal-title":"Lancet"},{"key":"pone.0255352.ref007","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.earlhumdev.2007.11.009","article-title":"Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control.","volume":"84","author":"C Gilbert","year":"2008","journal-title":"Early Hum Dev."},{"issue":"9814","key":"pone.0255352.ref008","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S0140-6736(11)61577-8","article-title":"Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review","volume":"379","author":"MK Mwaniki","year":"2012","journal-title":"Lancet"},{"key":"pone.0255352.ref009","first-page":"158","article-title":"Chronic lung disease in neonates: emerging problem in India.","volume":"39","author":"A Narang","year":"2002","journal-title":"Indian Pediatr"},{"key":"pone.0255352.ref010","doi-asserted-by":"crossref","first-page":"427","DOI":"10.4103\/0301-4738.86307","article-title":"Prevailing clinical practices regarding screening for retinopathy of prematurity among pediatricians in India: a pilot survey.","volume":"59","author":"SD Patwardhan","year":"2011","journal-title":"Indian J Ophthalmol"},{"issue":"4","key":"pone.0255352.ref011","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/dmcn.13675","article-title":"Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review.","volume":"60","author":"A Pascal","year":"2018","journal-title":"Dev Med Child Neurol"},{"issue":"3","key":"pone.0255352.ref012","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1179\/2046905515Y.0000000043","article-title":"Long-term neurodevelopmental outcome in high-risk newborns in resource-limited settings: a systematic review of the literature.","volume":"35","author":"KM Milner","year":"2015","journal-title":"Paediatr Int Child Health"},{"issue":"3","key":"pone.0255352.ref013","doi-asserted-by":"crossref","first-page":"e0120566","DOI":"10.1371\/journal.pone.0120566","article-title":"Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries\u2014a systematic review of outcomes measured.","volume":"10","author":"M Gladstone","year":"2015","journal-title":"PLoS One"},{"key":"pone.0255352.ref014","unstructured":"Viraraghavan Vadakkencherry Ramaswamy, Abiramalatha Thangaraj, Tapas Bandyopadhyay, Debasish Nanda, Prathik Bandya. Morbidity and mortality of extremely low gestational age neonates in low- and middle- Income Countries\u2013A Systematic Review and meta-analysis. https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=222873. Accessed 8th January 2021"},{"issue":"7","key":"pone.0255352.ref015","doi-asserted-by":"crossref","first-page":"e1000100","DOI":"10.1371\/journal.pmed.1000100","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.","volume":"6","author":"A Liberati","year":"2009","journal-title":"PLoS Med."},{"key":"pone.0255352.ref016","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014a web and mobile app for systematic reviews.","volume":"5","author":"M Ouzzani","year":"2016","journal-title":"Systematic Reviews."},{"key":"pone.0255352.ref017","unstructured":"World Bank Country and Lending Groups. https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups. Accessed 8th January 2021."},{"issue":"4","key":"pone.0255352.ref018","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0022-3476(78)80282-0","article-title":"Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm","volume":"92","author":"LA Papile","year":"1978","journal-title":"J Pediatr"},{"issue":"1","key":"pone.0255352.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging","volume":"187","author":"MJ Bell","year":"1978","journal-title":"Ann Surg"},{"issue":"7","key":"pone.0255352.ref020","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1001\/archopht.123.7.991","article-title":"The International Classification of Retinopathy of Prematurity revisited.","volume":"123","author":"International Committee for the Classification of Retinopathy of Prematurity","year":"2005","journal-title":"Arch Ophthalmol"},{"issue":"4","key":"pone.0255352.ref021","doi-asserted-by":"crossref","first-page":"280","DOI":"10.7326\/0003-4819-158-4-201302190-00009","article-title":"Assessing bias in studies of prognostic factors","volume":"158","author":"JA Hayden","year":"2013","journal-title":"Ann Intern Med"},{"issue":"2","key":"pone.0255352.ref022","doi-asserted-by":"crossref","first-page":"e20180933","DOI":"10.1542\/peds.2018-0933","article-title":"Survival and Impairment of Extremely Premature Infants: A Meta-analysis","volume":"143","author":"HT Myrhaug","year":"2019","journal-title":"Pediatrics"},{"key":"pone.0255352.ref023","doi-asserted-by":"crossref","DOI":"10.1002\/9780470693926","volume-title":"Systematic reviews in health care: Meta-analysis in context. 2","author":"M Egger","year":"2001"},{"key":"pone.0255352.ref024","doi-asserted-by":"crossref","first-page":"h870","DOI":"10.1136\/bmj.h870","article-title":"Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients","volume":"350","author":"A Iorio","year":"2015","journal-title":"BMJ"},{"issue":"6","key":"pone.0255352.ref025","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2188\/jea.15.235","article-title":"Systematic evaluation and comparison of statistical tests for publication bias.","volume":"15","author":"Y Hayashino","year":"2005","journal-title":"J Epidemiol"},{"key":"pone.0255352.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/2349-4220.159111","article-title":"Editorial: Improving neonatal survival in India.","volume":"2","author":"BV Bhat","year":"2015","journal-title":"Int J Adv Med Health Res"},{"issue":"9","key":"pone.0255352.ref027","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1111\/j.1440-1754.2012.02544.x","article-title":"Barriers to neonatal care in developing countries: parents\u2019 and providers\u2019 perceptions.","volume":"48","author":"AM Martinez","year":"2012","journal-title":"J Paediatr Child Health"},{"issue":"4","key":"pone.0255352.ref028","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ajog.2011.05.032","article-title":"Survival rates in extremely low birthweight infants depend on the denominator: avoiding potential bias by specifying denominators.","volume":"205","author":"U Guillen","year":"2011","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"pone.0255352.ref029","doi-asserted-by":"crossref","first-page":"F624","DOI":"10.1136\/archdischild-2018-316124","article-title":"Assessing the deprivation gap in stillbirths and neonatal deaths by cause of death: a national population-based study","volume":"104","author":"KE Best","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"pone.0255352.ref030","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jpeds.2016.04.083","article-title":"International Network for Evaluating Outcomes (iNeo) of Neonates. Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison.","volume":"177","author":"PS Shah","year":"2016","journal-title":"J Pediatr"},{"key":"pone.0255352.ref031","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jpeds.2019.08.028","article-title":"Outcomes at 18 to 22 Months of Corrected Age for Infants Born at 22 to 25 Weeks of Gestation in a Center Practicing Active Management","volume":"217","author":"PL Watkins","year":"2020","journal-title":"J Pediatr"},{"issue":"1","key":"pone.0255352.ref032","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1038\/s41372-018-0248-y","article-title":"Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation.","volume":"39","author":"CH Backes","year":"2019","journal-title":"J Perinatol"},{"issue":"3","key":"pone.0255352.ref033","doi-asserted-by":"crossref","first-page":"199","DOI":"10.21037\/tp.2019.07.10","article-title":"The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future.","volume":"8","author":"T Isayama","year":"2019","journal-title":"Transl Pediatr"},{"key":"pone.0255352.ref034","unstructured":"Indian Newborn Action Plan 2014. https:\/\/nhm.gov.in\/index4.php?lang=1&level=0&linkid=153&lid=174. Accessed 13th January 2021."},{"issue":"7","key":"pone.0255352.ref035","doi-asserted-by":"crossref","first-page":"e1002860","DOI":"10.1371\/journal.pmed.1002860","article-title":"Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study.","volume":"16","author":"C Hanson","year":"2019","journal-title":"PLoS Med."},{"issue":"3","key":"pone.0255352.ref036","doi-asserted-by":"crossref","first-page":"246","DOI":"10.21037\/tp.2019.07.03","article-title":"Economic assessment of neonatal intensive care.","volume":"8","author":"IGS Cheah","year":"2019","journal-title":"Transl Pediatr"},{"issue":"7778","key":"pone.0255352.ref037","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41586-019-1545-0","article-title":"Mapping 123 million neonatal, infant and child deaths between 2000 and 2017","volume":"574","author":"R Burstein","year":"2019","journal-title":"Nature"},{"issue":"4","key":"pone.0255352.ref038","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1159\/000320332","article-title":"Reducing global neonatal mortality is possible.","volume":"99","author":"OD Saugstad","year":"2011","journal-title":"Neonatology"},{"issue":"12","key":"pone.0255352.ref039","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1001\/jama.2019.2021","article-title":"Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004\u20132007 and 2014\u20132016","volume":"321","author":"M Norman","year":"2019","journal-title":"JAMA"},{"issue":"1","key":"pone.0255352.ref040","doi-asserted-by":"crossref","first-page":"e000211","DOI":"10.1136\/bmjpo-2017-000211","article-title":"Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks\u2019 gestation: a retrospective observational study in tertiary centres in Japan.","volume":"2","author":"Y Kono","year":"2018","journal-title":"BMJ Paediatr Open"},{"issue":"3","key":"pone.0255352.ref041","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1001\/jamapediatrics.2014.3351","article-title":"Survival and morbidity of preterm children born at 22 through 34 weeks\u2019 gestation in France in 2011: results of the EPIPAGE-2 cohort study","volume":"169","author":"EPIPAGE-2 Writing Group","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"10","key":"pone.0255352.ref042","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993\u20132012","volume":"314","author":"BJ Stoll","year":"2015","journal-title":"JAMA"},{"key":"pone.0255352.ref043","doi-asserted-by":"crossref","first-page":"e7976","DOI":"10.1136\/bmj.e7976","article-title":"Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies).","volume":"345","author":"KL Costeloe","year":"2012","journal-title":"BMJ"},{"issue":"3","key":"pone.0255352.ref044","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1136\/archdischild-2019-318402","article-title":"Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice","volume":"105","author":"H Mactier","year":"2020","journal-title":"Arch Dis Child Fetal Neonatal Ed"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255352","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T18:11:31Z","timestamp":1628187091000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255352"}},"subtitle":[],"editor":[{"given":"Harald","family":"Ehrhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,8,5]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0255352","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,5]]}}}