The prevalence of long-term neurodevelopmental outcomes in preterm-born children in low- and middle-income countries: a systematic review and meta-analysis of developmental outcomes in 72 974 preterm-born children.

Background: Preterm birth is associated with an increased risk of adverse neurodevelopmental outcomes. However, prevalence estimates of adverse neurodevelopmental outcomes on preterm born children in low - and middle - income countries (LMICs) remain unclear. In this systematic review and meta-analysis, we aim to estimate the prevalence of adverse neurodevelopmental outcomes in preterm-born children in LMICs. Methods: We comprehensively searched six electronic databases - Medline, Embase, CINAHL, PsycInfo, Scopus, and Web of Science, without language and date restrictions. We included observational studies conducted in LMICs that reported prevalence of any type of neurodevelopmental outcome in children born preterm using a validated method or clinical diagnosis, and outcome measurement was performed in at least 100 eligible children at age ≥12 months. The primary outcomes of interest were a composite of any neurodevelopmental impairment, cerebral palsy, visual impairment/blindness, hearing impairment/deafness, motor impairment, developmental delays, learning difficulties, and adverse behavioural and socio-emotional outcomes. We used the JBI critical appraisal checklist to assess the quality of the included studies, and prevalence estimates were calculated using a random-effects meta-analysis model. Results: A total of 47 data sets from 12 countries involving 72 974 preterm-born children were included. The estimated pooled prevalence of overall neurodevelopmental impairment and cerebral palsy was 16% (95% confidence interval (CI) = 11-21%) and 5% (95% CI = 3-6%), respectively. The pooled prevalence of developmental delays across different domains ranged from 8 to 13%. Lower prevalence was found in hearing impairment/deafness and visual impairment/blindness (1%). Higher prevalences were observed with decreasing gestational age and birth weight. Conclusions: There is a high burden of adverse neurodevelopmental outcomes in preterm born children in LMICs. Such prevalence estimates are essential in informing clinical and public health policy, allocating scarce resources, and directing further research to improved outcomes in these settings. Registration: PROSPERO: CRD42024569564.