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

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.