Meta-Analysis
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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Nov 9, 2021; 10(6): 177-191
Published online Nov 9, 2021. doi: 10.5409/wjcp.v10.i6.177
Table 1 Characteristics of studies included in the meta-analysis
Ref. Year Timing of data collection Study design Country Population size Cases with PH Prevalence of PH De Rubens et al [48 ] 2003 Retrospective Observational Mexico 275 41 14.90909 Shah et al [33 ] 2004 Retrospective Observational Canada 175 24 13.71429 Cua et al [35 ] 2007 Retrospective Observational USA 58 7 12.06897 Weijerman et al [40 ] 2010 Prospective Cohort Netherlands 820 25 3.04878 Banjar et al [41 ] 2012 Retrospective Observational Saudi Arabia 59 44 74.57 Mourato et al [42 ] 2013 Retrospective Cross-sectional Brazil 138 42 30.43478 Sharma et al [43 ] 2013 Prospective Observational India 35 18 51.42857 Shrestha et al [36 ] 2013 Prospective Observational Nepal 50 21 42 Espinola-Zavaleta et al [44 ] 2015 Prospective Observational Mexico city 127 102 80.31496 Bermudez et al [34 ] 2015 Retrospective Observational Brazil 1207 57 4.722452 Zonouzi et al [45 ] 2015 Prospective Cross-sectional Iran 110 23 20.90909 Joffre et al [6 ] 2016 Retrospective Observational France 66 19 28.78788 Okeniyi et al [37 ] 2017 Prospective Observational Nigeria 70 14 20 Bush et al [38 ] 2018 Retrospective Cohort USA 1252 346 27.63578 Martin et al [39 ] 2018 Retrospective Cohort Ireland 121 41 33.8843 Zahari et al [46 ] 2019 Retrospective Cohort Malaysia 754 160 21.22016 Alsuwayfee et al [47 ] 2020 Prospective Cross-sectional Iraq 76 23 30.26
Table 2 Screening methodology of the included studies
Ref. Diagnosis established by Age group, (mean ± SD, yr) Sex (M:F) Diagnostic criteria for PH De Rubens et al [48 ] Echocardiography Less than 16 yr 1:1 NM Shah et al [33 ] Echocardiography Newborn 10:7 Right to left shunting at ductal or atrial level in the absence of severe pulmonary parenchymal disease Cua et al [35 ] Echocardiography Neonate 25:33 Right-to-left shunt at the ductal level or flattening of the IVS in the absence of a PDA Weijerman et al [40 ] Echocardiography Neonate NM Right-to-left shunt at the ductal level Banjar et al [41 ] Echocardiography 3.3 ± 3.9 34:25 > 50% of systolic systemic pressure Mourato et al [42 ] Echocardiography Infant 61:77 mPAP > 25 mmHg Sharma et al [43 ] Echocardiography Less than 12 yr 4:3 mPAP >25 mmHg Shrestha et al [36 ] Echocardiography 4 mo to 12 yr 1:1.4 NM Espinola-Zavaleta et al [44 ] Echocardiography Up to 18 yr 64:63 mPAP > 30 mm Hg Bermudez et al [34 ] Echocardiography Up to 11 mo NM mPAP > 25 mmHg Zonouzi et al [45 ] Echocardiography 1 mo-20 yr 53:57 NM Joffre et al [6 ] Echocardiography 1mo-16 yr 2:1 NM Okeniyi et al [37 ] Echocardiography 3 mo-9 yr 3:4 NM Bush et al [38 ] Echo or catheterization Birth to 21 yr 688:564 mPAP > 25 mmHg; IVS flattening, RV dilation, or presence of RV hypertrophy Martin et al [39 ] Echocardiography Neonate 62:59 Right to-left shunt across the PDA, IVS bowing into the left ventricle, or the presence of a TR jet Zahari et al [46 ] Echocardiography Newborn 189:225 IVS flattening, a dilated main pulmonary artery, and dilated right cardiac chambers Alsuwayfee et al [47 ] Echocardiography < 15 yr 0.85:1 mPAP > 25 mmHg
Table 3 Quality assessment of the included studies
STROBE quality of reporting Ref. The title and abstract (Item 1) Introduction (Item 2-3) Methods (Item 4-12) Results (Item 13-17) Discussion and other information (Item 18-22) Quality score (0-22) De Rubens et al [48 ] 1 2 6 4 2 15 Shah et al [33 ] 0 2 5 2 3 12 Cua et al [35 ] 1 2 5 3 4 15 Weijerman et al [40 ] 1 2 4 4 4 15 Banjar et al [41 ] 1 2 4 4 4 15 Mourato et al [42 ] 1 2 5 2 4 14 Sharma et al [43 ] 1 2 5 3 4 15 Shrestha et al [36 ] 1 2 4 4 4 15 Espinola-Zavaleta et al [44 ] 1 2 5 3 3 14 Bermudez et al [34 ] 1 2 4 2 4 13 Zonouzi et al [45 ] 1 2 4 3 5 15 Joffre et al [6 ] 1 2 5 2 4 14 Okeniyi et al [37 ] 1 2 5 3 3 14 Bush et al [38 ] 1 2 5 3 5 16 Martin et al [39 ] 1 2 5 4 4 16 Zahari et al [46 ] 1 2 5 3 4 15 Alsuwayfee et al [47 ] 1 2 5 4 4 16
Table 4 Risk of bias assessment of included studies using the Hoy
et al [
26 ] 2012 tool
Ref. Representation Sampling Random selection Non response bias Data collection Case definition Reliability and validity of study tool Method of data collection Prevalence period Numerator and denominator Summary assessment De Rubens et al [48 ] HR HR HR HR HR HR LR LR HR LR HR Shah et al [33 ] HR HR HR HR HR HR LR LR HR LR HR Cua et al [35 ] LR LR LR LR LR LR LR LR HR LR LR Weijerman et al [40 ] HR HR HR HR HR LR LR LR HR LR MR Banjar et al [41 ] HR HR LR HR LR HR LR LR LR LR MR Mourato et al [42 ] HR HR HR HR LR LR LR LR HR LR MR Sharma et al [43 ] HR LR LR HR LR LR LR LR LR LR LR Shrestha et al [36 ] LR LR LR HR LR LR LR LR HR LR LR Espinola-Zavaleta et al [44 ] LR LR LR HR HR HR LR LR HR LR MR Bermudez et al [34 ] LR LR HR HR LR HR LR LR HR LR MR Zonouzi et al [45 ] HR HR HR HR LR HR LR LR HR LR MR Joffre et al [6 ] HR HR HR HR HR HR HR HR LR LR HR Okeniyi et al [37 ] LR LR LR HR HR LR LR LR HR LR LR Bush et al [38 ] LR LR LR HR HR LR LR LR HR LR LR Martin et al [39 ] LR LR LR HR HR LR LR LR HR LR LR Zahari et al [46 ] HR LR HR HR LR HR LR LR HR LR MR Alsuwayee et al [47 ] HR HR HR HR LR LR LR LR LR LR MR
Table 5 Prevalence in different subgroups
Stratification group Number of studies Total number of subjects Total number of events I 2 P value Prevalence 95%CI Sex Male 4 801 210 28.22 0.243 24.3 18.8-30.6 Female 4 695 189 56.44 0.076 26.2 18.8-35.3 Age Infant (< 1 yr) 7 3273 356 95.35 0.000 13.4 6.6-25.4 Children (> 1 yr) 9 2061 607 94.68 0.000 33.7 22.6-47.0 Region Asia 6 1084 289 93.68 0.000 38.4 23.7-55.7 Not Asia 11 4309 718 97.92 0.000 19.8 10.9-33.2 Studies published Before 2011 4 1328 97 93.79 0.000 9.4 4.1-20.2 2011 - 2020 13 4065 910 97.13 0.000 33.0 22.5-45.4 Risk of bias High risk 3 516 84 76.20 0.015 17.8 11.6-26.5 Moderate risk 8 2119 437 97.91 0.000 34.0 16.6-57.1 Low risk 6 2758 486 97.63 0.000 20.0 9.3-37.7 Etiology Cardiac 7 724 372 97.06 0.000 14.4 7.4-26.1 Non-cardiac 7 724 352 96.63 0.000 8.9 4.4-17.5