Evidence map›Paper›PMID 40100814›Full record

SynthesisPloS one2025

Active versus restrictive approach to isolated hypotension in preterm neonates: A Systematic Review, Meta-analysis and GRADE based Clinical Practice Guideline.

Viraraghavan Vadakkencherry Ramaswamy, Gunjana Kumar, Abdul Kareem Pullattayil S, Abhishek S Aradhya, Pradeep Suryawanshi, Mohit Sahni, Supreet Khurana, Kiran More, National Neonatal Forum, India, Clinical Practice Guidelines Group on Neonatal Shock

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Viraraghavan Vadakkencherry RamaswamyDepartment of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India.ORCID https://orcid.org/0000-0001-7092-3597
Gunjana KumarDepartment of Neonatology, National Institute of Medical Sciences, Jaipur, Rajasthan, India.
Abdul Kareem Pullattayil SQueen's University, Kingston, Canada.ORCID https://orcid.org/0000-0002-6718-5228
Abhishek S AradhyaDepartment of Neonatology, Ovum Women and Child Speciality Hospital, Bengaluru, Karnataka, India.
Pradeep SuryawanshiDepartment of Neonatology, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India.
Mohit SahniDepartment of Neonatology, Surat Kids Hospital, Surat, Gujarat, India.
Supreet KhuranaDepartment of Neonatology, Government Medical College and Hospital, Chandigarh, India.
Kiran MoreDivision of Neonatology, MRR Children's Hospital, Mumbai, Maharashtra, India.ORCID https://orcid.org/0000-0002-1786-0002
National Neonatal Forum, India, Clinical Practice Guidelines Group on Neonatal Shock

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveIsolated hypotension (IH) without any clinical or biochemical features of poor perfusion is a common occurrence in very preterm infants (VPTI). There exists no recommendations guiding its management.The objective of this review was to compare the effect of active vs. restrictive approach to treat IH in VPTI. METHODOLOGY: Medline, Embase and Web of Science were searched until 1st April 2024. RCTs and non-RCTs were included. Mortality, major brain injury (MBI) (intraventricular hemorrhage >  grade 2 or cystic periventricular leukomalacia), mortality or neurodevelopmental impairment (NDI) at 18-24 months' corrected age were the critical outcomes evaluated.

results44 studies were included: 9 were synthesized in a meta-analysis and 35 studies in the narrative review. Clinical benefit or harm could not be ruled out for the outcomes from the meta-analyses of RCTs. Meta-analysis of 3 non-RCTs suggested that active treatment of IH in VPTI of <  24 hours of life possibly increased the odds of MBI (aOR: 95% CI 1.85 (1.45; 2.36), very low certainty). Meta-analysis of 2 non-RCTs that had included VPTI <  72 hours indicated a possibly decreased risk of MBI (aOR: 95% CI 0.44 (0.24; 0.82), very low certainty) and NEC ≥  stage 2 (aOR: 95% CI 0.61 (0.41; 0.92), very low certainty) with active treatment of IH. Active treatment of IH in the first 24 hours possibly increased the risk of mortality or long-term NDI (aOR: 95% CI 1.84 (1.10; 3.09), very low certainty) and the risk of hearing loss at 2 years (aOR: 95% CI 3.60 (1.30; 9.70), very low certainty). Clinical benefit or harm could not be ruled out for other outcomes. There was insufficient evidence with respect to preterm neonates of ≥  32 weeks.

conclusionsIH may not be treated in VPTI in the first 24 hours. However, IH occurring between 24 hours - 72 hours of life may be treated. The evidence certainty was very low.

Indexed as

HypotensionInfant, PrematureHumansInfant, NewbornPractice Guidelines as Topic

Identifiers

PMID40100814
PMCPMC11918419

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Registered trials

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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.