SynthesisEuropean journal of pediatrics2025
Evidence certainty in neonatology-a meta-epidemiological analysis of Cochrane reviews.
Synthesis in European journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Limited Evidence of Noradrenaline Use and Effectiveness in Preterm Neonates: A Systematic Review.Acta paediatrica (Oslo, Norway : 1992) · 2026Pooled it
- Value-based neonatology (VBN): a new ethical paradigm for newborn care.European journal of pediatrics · 2026Review
- Feasibility of a German High-Frequency Neonatal and Pediatric Intensive Care Dataset (AIx-Neo-Guard Dataset): Secondary Data Cohort Study.JMIR pediatrics and parenting · 2026Article
- How consistent are recent neonatal resuscitation guidelines?Resuscitation plus · 2026Review
- A critical moment for neonatology: appeals from the Lancet Child & Adolescent Health Commission.Italian journal of pediatrics · 2026Article
- Informed consent, randomization, and blinding in neonatal resuscitation and immediate care trials.Resuscitation plus · 2026Article
- Neonatology: First Exposure to Antibiotics from the Ethical Perspective of Parents, Physicians, and Regulators.Antibiotics (Basel, Switzerland) · 2025Article
- Negative Results in Neonatal Trials: Clinical Lessons and Future Directions - A Narrative Review.Biomedicine hubReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We hypothesized that certainty of the available evidence is relatively low in neonatology. Thus, we designed a meta-epidemiological review to examine what is the certainty of evidence in the latest Cochrane neonatal reviews and investigate if the number of trials and enrolled patients is associated with the certainty of evidence. We searched Cochrane neonatal reviews published between January 2022 and May 2024. We included all reviews on interventions concerning neonates that had at least one meta-analysis performed with GRADE-rated evidence certainty. From those reviews, we extracted the presented certainty of evidence and analyzed its association with the number of trials and participants by ANOVA. We screened 55 Cochrane reviews and included 49 of them. In these 49 reviews, there were 443 reported outcomes with graded certainty of evidence. The certainty was reported to be high in 8 (1.8%), moderate in 89 (20.2%), low in 195 (44.0%), and very low in 151 (34%) of the outcomes. Reviews reporting outcomes with higher certainty of evidence had significantly more trials and patients (approximately 3 and 1.5 times more, respectively) than those with only low certainty of evidence.
conclusionIn the past 2 years, Cochrane neonatal reviews have generally had low or very low certainty of evidence for most outcomes. Only 2% of the reviewed outcomes had high certainty. The number of included patients and trials significantly affected the certainty. These findings highlight the continuous need for better quality and larger trials. WHAT IS KNOWN: • Neonatology is among the largest specialities and the evidence certainties of interventions have been varying. • Neonatal patients and studies need to consider the uniqueness of the patients and the acute situations in the study designs. WHAT IS NEW: • The included 49 reviews consisted of 443 outcomes and of these only 1.8% were classified as high certainty of evidence. • Higher evidence certainties were associated with higher number of included trials and participants.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.