Systematic Cochrane Reviews in Neonatology: A Critical Appraisal

Willhelm, Christiane; Girisch, Wolfgang; Gottschling, Sven; Gräber, Stefan; Wahl, Holger; Meyer, Sascha

doi:10.1016/j.pedneo.2013.03.002

Cited by 29 publications

(15 citation statements)

References 21 publications

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“… 48 In rheumatology widespread adoption has led to full reporting of the rheumatoid arthritis core outcome set in 80% of relevant trials. 49 Similar uptake in neonatal research would reduce barriers to meta-analysis 10 and aid translation of research findings into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately there is a paucity of high-quality evidence to guide much neonatal practice, leading to variation in clinical care 6 7 and outcomes. 8 9 One reason research fails to guide practice is because neonatal meta-analyses rarely provide conclusive recommendations, 10 11 commonly because trials have used heterogeneous, non-comparable outcomes. 12 13 A further limitation of neonatal and paediatric research is that the outcomes reported are frequently not meaningful to patients and parents.…”

Section: Introductionmentioning

confidence: 99%

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Core outcomes in neonatology: development of a core outcome set for neonatal research

Webbe

Duffy

Afonso

et al. 2019

Arch Dis Child Fetal Neonatal Ed

137

121

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BackgroundNeonatal research evaluates many different outcomes using multiple measures. This can prevent synthesis of trial results in meta-analyses, and selected outcomes may not be relevant to former patients, parents and health professionals.ObjectiveTo define a core outcome set (COS) for research involving infants receiving neonatal care in a high-income setting.DesignOutcomes reported in neonatal trials and qualitative studies were systematically reviewed. Stakeholders were recruited for a three-round international Delphi survey. A consensus meeting was held to confirm the final COS, based on the survey results.ParticipantsFour hundred and fourteen former patients, parents, healthcare professionals and researchers took part in the eDelphi survey; 173 completed all three rounds. Sixteen stakeholders participated in the consensus meeting.ResultsThe literature reviews identified 104 outcomes; these were included in round 1. Participants proposed 10 additional outcomes; 114 outcomes were scored in rounds 2 and 3. Round 1 scores showed different stakeholder groups prioritised contrasting outcomes. Twelve outcomes were included in the final COS: survival, sepsis, necrotising enterocolitis, brain injury on imaging, general gross motor ability, general cognitive ability, quality of life, adverse events, visual impairment/blindness, hearing impairment/deafness, retinopathy of prematurity and chronic lung disease/bronchopulmonary dysplasia.Conclusions and relevanceA COS for clinical trials and other research studies involving infants receiving neonatal care in a high-income setting has been identified. This COS for neonatology will help standardise outcome selection in clinical trials and ensure these are relevant to those most affected by neonatal care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Core outcomes in neonatology: development of a core outcome set for neonatal research

Webbe

Duffy

Afonso

et al. 2019

Arch Dis Child Fetal Neonatal Ed

137

121

View full text Add to dashboard Cite

show abstract

“…The usefulness of systematic reviews and meta‐analyses is commonly limited; however, because trials examining the same intervention often report different outcomes, or where the same outcomes are reported, they are measured in different ways. This has been noted across multiple areas of health care research . Conflicting trial outcomes therefore limit the evidence base and create confusion for practitioners, decision makers, and the public when deciding on the most effective treatment for a condition…”

Section: Introductionmentioning

confidence: 99%

Adding value to core outcome set development using multimethod systematic reviews

Brunton

Webbe

Oliver

et al. 2020

Research Synthesis Methods

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Trials evaluating the same interventions rarely measure or report identical outcomes. This limits the possibility of aggregating effect sizes across studies to generate high‐quality evidence through systematic reviews and meta‐analyses. To address this problem, core outcome sets (COS) establish agreed sets of outcomes to be used in all future trials. When developing COS, potential outcome domains are identified by systematically reviewing the outcomes of trials, and increasingly, through primary qualitative research exploring the experiences of key stakeholders, with relevant outcome domains subsequently determined through transdisciplinary consensus development. However, the primary qualitative component can be time consuming with unclear impact. We aimed to examine the potential added value of a qualitative systematic review alongside a quantitative systematic review of trial outcomes to inform COS development in neonatal care using case analysis methods. We compared the methods and findings of a scoping review of neonatal trial outcomes and a scoping review of qualitative research on parents', patients', and professional caregivers' perspectives of neonatal care. Together, these identified a wider range and greater depth of health and social outcome domains, some unique to each review, which were incorporated into the subsequent Delphi process and informed the final set of core outcome domains. Qualitative scoping reviews of participant perspectives research, used in conjunction with quantitative scoping reviews of trials, could identify more outcome domains for consideration and could provide greater depth of understanding to inform stakeholder group discussion in COS development. This is an innovation in the application of research synthesis methods.

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“…An additional consideration is, as perhaps expected, the evidence base for many practices of neonatal care is poorly developed. Randomized trials for many otherwise accepted practices remain to be undertaken . This raises questions about how far practices underpinned by trials in other patient settings should be extrapolated to neonatal care.…”

Section: Introductionmentioning

confidence: 99%

The practice of transfusion and fluid bolus therapy in neonates

Keir

Stanworth

2018

ISBT Science Series

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There is increasing uncertainty over the potential benefits and harms of volume expansion in paediatric and adult critical care settings. In addition, there are increasing numbers of reports of adverse effects and association with RBC transfusions in neonates, including transfusion‐associated necrotizing enterocolitis. Preterm infants <28 weeks’ gestation in particular are likely more vulnerable to volume shifts and changes in blood pressure due to their unique physiology. This review paper will provide an overview of the current evidence base supporting the use of RBC transfusion thresholds and the use of fluid bolus therapy in neonates. We will argue that enhanced data collection and collaborations through neonatal networks, development of international consensus definitions of transfusion adverse effects and associations, as well as haemodynamic compromise in neonates, are needed to further advance research in these areas.

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Systematic Cochrane Reviews in Neonatology: A Critical Appraisal

Abstract: There is an ongoing need for high-quality research in order to reduce the proportion of inconclusive meta-analyses in the field of neonatology. Funding and research agencies will play a vital role in selecting the most appropriate research programs.

Cited by 29 publications

References 21 publications

Core outcomes in neonatology: development of a core outcome set for neonatal research

Core outcomes in neonatology: development of a core outcome set for neonatal research

Adding value to core outcome set development using multimethod systematic reviews

The practice of transfusion and fluid bolus therapy in neonates

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