Respiratory infections in children born preterm in low and middle-income countries: A systematic review

Abstract

Context: Studies from high-income countries indicates that infants born preterm are at increased risk of respiratory infections; however in the low and middle-income countries (LMICs) data are limited. Our aim was to systematically review the studies evaluating the risk of respiratory infections in preterm children born in LMICs. Methods: We searched Medline, PubMed, Cumulative Index of Nursing and Allied Health Literature, Embase, and Psych-INFO databases for studies reporting respiratory outcomes in children born preterm in LMICs. Two authors extracted the data and evaluated the risk of bias with appropriate assessment methods independently. Results: Twelve observational studies evaluating 5969 children were included in the review. The risk of lower respiratory tract infection varied from 5% to 73.9%. Similarly, respiratory syncytial virus (RSV) infection risk ranged from 4.4% to 22.7%. The unadjusted relative risk for any respiratory tract infection or lower respiratory tract infection was significantly higher in the children born preterm than in children born at term (1.52 [95% confidence interval 1.25–1.85]). We also noted wide-ranging risk of respiratory infections requiring in-hospital or emergency care (range: 0.5%–27.7%) and hospital stay in children born preterm (range: 6–14.3 days). Conclusions: Preterm-born children in LMICs are at risk of increased respiratory infections compared to term-born children; however, the baseline risk is variable, although substantial; This highlights the need for preventive strategies, including RSV immunoprophylaxis.