Meta-analysis finds high mortality and morbidity for neonates on mechanical ventilation in low-resource settings

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European journal of pediatrics Published May 7, 2026 Medically reviewed May 14, 2026 Study authors: Krishnegowda Vijay Kumar, Ramaswamy Viraraghavan Vadakkencherry, Bandiya Prathik, Bandyopadhyay Tapa… PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider the very low certainty evidence when interpreting high mortality and morbidity rates for neonates on mechanical ventilation in low-resource settings.

A systematic review and prognostic meta-analysis synthesized evidence on neonates receiving invasive mechanical ventilation in low-resource settings, primarily in South Asia. The main finding was a high pooled estimate for in-hospital mortality. The authors also reported pooled rates for several secondary outcomes, including bronchopulmonary dysplasia, intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, ventilator-associated pneumonia, sepsis, and pulmonary haemorrhage. A modest improvement in survival was noted in the past decade compared to earlier epochs.

Key limitations highlighted by the authors include heterogeneous outcome definitions, a predominance of unadjusted analyses, and a current evidence base restricted to single-centre observational studies. The authors noted that evidence-certainty for all outcomes was very low.

The authors suggested that improving outcomes requires moving beyond mere access to invasive mechanical ventilation and investing in comprehensive training and scaling up critical auxiliary resources. Given the observational nature of the included studies and very low certainty, the findings should be interpreted cautiously.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42096067

View Original Abstract ↓

Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current evidence base being restricted to single-centre observational studies, thus limiting comparative analyses and effective healthcare planning. This study aims to estimate the pooled proportion of mortality and morbidity among neonates exposed to IMV in low-resource settings. Medline, Embase, and CENTRAL were searched until 22 August 2025. Randomised and non-randomised studies were included. Two reviewers, blinded to each other, extracted data independently. Proportion-based meta-analyses using random-effects model were performed. Risk of bias was assessed using ROBINS-E, and evidence-certainty was evaluated using the GRADE approach. One hundred of 117 studies were included, with most conducted in South Asia. In-hospital mortality was reported in 68 studies (7193 neonates), with a pooled estimate of 45% (39%-50%), evidence-certainty being very low. Among the secondary outcomes, the pooled rates were as follows: bronchopulmonary dysplasia, 10% (5%-18%); intraventricular haemorrhage (any grade), 10% (5%-19%); necrotising enterocolitis (any stage), 14% (6%-31%); retinopathy of prematurity (any stage), 33% (22%-46%); ventilator-associated pneumonia, 21% (14%-29%); sepsis, 32% (25%-40%) and pulmonary haemorrhage, 9% (6%-14%). Evidence-certainty for all the secondary outcomes was also very low. Subgroup analysis comparing two distinct time epochs revealed a significant difference in mortality, 43% (36%-50%) (I = 93.5%) in the post-2010 epoch compared to 55% (48%-63%) (I = 82.9%) in the pre-2010 epoch (p = 0.004). Heterogeneous outcome definitions and predominance of unadjusted analyses across studies limit the existing evidence.Conclusions: In LRS, the mortality and morbidity rates among neonates receiving IMV remain substantially high with a modest improvement in survival in the past decade. Improving outcomes mandates moving beyond access to the provision of IMV to investing in comprehensive training and scaling up critical auxiliary resources. Future research must adopt standardised outcome definitions and adjusted analyses to precisely quantify the impact of IMV in LRS.