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.

Surveillance of Viral Respiratory Infections in the Neonatal Intensive Care Unit—Evolution in the Last 5 Years

“…A well stablished surveillance routine, using advanced PCR diagnostic technology, will contribute to an earlier and more accurate detection of respiratory viruses compared to traditional antigen tests and virus cultures [ 18 ]. VRIs are an important determinant of morbidity in vulnerable populations [ 2 , 19 ] and represent an immunologic challenge [ 20 ]. Our research suggests that premature infants with symptomatic VRIs during NICU admission have an increased risk of developing recurrent wheezing during the first two years of age.…”

“…Viral respiratory infections (VRIs) are very common among children, often causing mild disease, although they can be asymptomatic. However, these infections are associated with higher rates of morbidity if they occur in preterm infants with a greater need for supplementary oxygen, later acquisition of full enteral nutrition, and longer hospital stay, especially in those who suffer bronchopulmonary dysplasia [ 1 , 2 , 3 ].…”

Transfer of Respiratory Syncytial Virus Prefusion F Protein Antibody in Low Birthweight Infants

“…Respiratory syncytial virus (RSV)–associated lower respiratory tract infection contributes significantly to infant morbidity and mortality worldwide [ 1 , 2 ]. Infants with low birthweight (LBW), defined as <2500 g, such as those born prematurely (<37 weeks’ gestational age [GA]) or with birthweight small for GA (SGA; <10 th percentile for GA) are especially at risk for serious sequelae from common respiratory viruses including RSV [ 3–6 ]. Maternal immunization, the transfer of maternal antibody across the placenta, is an important mechanism for prevention of serious infections in early infancy [ 7 , 8 ].…”