Children born preterm admitted to paediatric intensive care for bronchiolitis: A systematic review and meta-analysis

<p>Background</p> <p>To undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term.</p> <p><br></p> <p>Methods</p> <p>We searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0–18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis.</p> <p><br></p> <p>The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU.</p> <p><br></p> <p>We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias.</p> <p><br></p> <p>Results</p> <p>We included 31 studies, from 16 countries, including a total of 18,331 children.</p> <p><br></p> <p>Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups.</p> <p><br></p> <p>The majority of studies (n = 26, 84%) were at high risk of bias.</p> <p><br></p> <p>Conclusions</p> <p>Among PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.</p>