Evidence map›Paper›PMID 42639700›Full record

SynthesisPediatric pulmonology2026

Association Between Diaphragm Ultrasound Measures and Extubation Outcomes in Neonates: A Systematic Review and Meta-Analysis.

Mayson L A Sousa, Eleonora Balzani, Sebastian Dubo, Amanda A C Coelho, Taylor Davidson, Glasiela Alcala, Me-Linh Le, Shyamala Dakshinamurti, Yasser Elsayed, Annia F Schreiber

Abstract readSystematic ReviewMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Pediatric pulmonology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–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 synthesis or guideline pooled it.

  1. Pooled it
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

10 authors.

Mayson L A SousaDepartment of Respiratory Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.ORCID https://orcid.org/0000-0003-4236-5107
Eleonora BalzaniCentre for Medical Sciences-CISMed, University of Trento, Trento, Italy.ORCID https://orcid.org/0000-0001-7837-4457
Sebastian DuboDepartamento de Kinesiología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.ORCID https://orcid.org/0000-0002-3206-0433
Amanda A C CoelhoServiço de Fisioterapia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.
Taylor DavidsonDepartment of Respiratory Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Glasiela AlcalaToronto General Hospital Research Institute, Toronto, Ontario, Canada.
Me-Linh LeNeil John Maclean Health Sciences Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Shyamala DakshinamurtiChildren's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.ORCID https://orcid.org/0000-0001-7279-5226
Yasser ElsayedSection of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
Annia F SchreiberInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0003-4073-4001

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWe conducted a systematic review and prognostic meta-analysis to evaluate the association between ultrasound-derived measures of diaphragm structure and contractile activity with the risk of extubation failure in mechanically ventilated neonates. DATA SOURCES: MEDLINE, Embase, the Cochrane Library, CINAH, Scopus, and ClinicalTrials.gov were systematically searched from inception to January 12, 2026, without using language restrictions. STUDY SELECTION: Observational studies including mechanically ventilated neonates (≤ 28 days old) undergoing planned extubation in whom diaphragmatic thickness, thickening fraction, or excursion were measured by ultrasound and extubation outcome were reported. Studies involving congenital diaphragmatic or neuromuscular disorders were excluded. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random-effects meta-analyses were conducted using mean differences (MD) with 95% confidence intervals (CI).

resultsOf 1,522 records identified, 110 full-text articles were assessed, and seven prospective cohort studies (n = 255 neonates) met the inclusion criteria. Extubation failure occurred in 90 neonates (35%). Neonates who failed extubation had significantly lower diaphragm thickening fraction compared with those successfully extubated (MD = -9.51%; 95% CI: -14.73 to -4.29; p = 0.0004; I

conclusionsLower diaphragm thickening fraction is associated with extubation failure in mechanically ventilated neonates. Standardization of measurement protocols and prospective validation studies are needed before diaphragm ultrasound can be incorporated into routine extubation decision-making. REGISTRATION: PROSPERO CRD420251045024.

Indexed as

Airway ExtubationDiaphragmHumansInfant, NewbornRespiration, ArtificialUltrasonographyVentilator Weaningdiaphragmextubationinfantmechanical ventilationnewbornrespiratory musclesultrasonographyweaning

Identifiers

PMID42639700
PMCPMC13504643

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.