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Interventions to improve rates of successful extubation in preterm infants: a systematic review and
meta-analysis. Nasal CPAP or intubation at birth for very preterm infants. Systematic reviews in this
field and others should be rigorously peer-reviewed before publication to avoid misleading readers to
potentially biased conclusions. A systematic review of the current literature can provide information
that may be combined, thus increasing statistical power and providing a quantitative estimate of the
effect in a meta-analysis ( 3 ). An example of such an outcome in neonatal practice is nasal CPAP
failure or intubation for mechanical ventilation. Should neonates less than 25 weeks’ gestation be
resuscitated. Results: Most of the studies were descriptive and cross-sectional (50%), using
peripheral venous catheter (62.5%). The years varied between 2006 and 2014. You can download the
paper by clicking the button above. The included study by Kribs used LISA and compared this to
surfactant administration with mechanical ventilation. First, the magnitude and direction of the
treatment effect across the different studies should be relatively similar and that there are no
significant variations in the results that could be explained by relevant differences among the studies.
When one performs a systematic review, one forgoes the ability to conduct logistic regression
analysis using center effect as a variable. A recently published systematic review by Wu et al. It
would not be correct to claim a certain magnitude of effect of a certain intervention if it is being
compared to anything different than the standard of care for the control group, since this could
potentially overestimate the real effect of the intervention. The goal of this literature review is to
analyze the existing information on. Unfortunately, this statistic can only detect the mathematical
heterogeneity in the individual point estimates of the effect but will not reflect relevant differences
within the studies. FM and SD: substantial contribution to the analysis and interpretation of the
work. There were 47 cases of adverse outcomes from 35 articles included in the analysis.
Heterogeneity among studies is a potential source of bias and may not always be detected by
statistical tests. The studies should be combined only if they lack significant bias, if they answer the
same specific question, if they include similar populations, and if they attempt to compare similar
interventions and measure equivalent outcomes, so that a pooled effect of the results from individual
studies yields a more precise and representative estimate of the treatment effect ( 6 ). Therefore,
heterogeneity between studies in a meta-analysis needs to be examined as much more than a simple
statistical test, and clearly, one more relevant issue when critically appraising a systematic review.
Studies were included if they reported on the outcomes of neonatal. This is an open-access article
distributed under the terms of the Creative Commons Attribution License (CC BY). The challenge is
to combine studies that address a specific clinical question and have similar characteristics in terms
of populations, interventions, comparators, and outcomes, so that their combined results provide a
more precise estimate of the effect that can be validly extrapolated into clinical practice. Drafting
and revising the manuscript critically for important intellectual content. These data did not support
concerns of water aspiration or cord rupture, but did identify other potential risks. A frequently used
test for evaluating heterogeneity is the I 2 statistic that estimates the heterogeneity as the magnitude
of variability. This is an important difference compared to the other trials included in this systematic
review, where a more select population of preterm infants was enrolled. Nasal masks or binasal
prongs for delivering continuous positive airway pressure in preterm neonates-a randomised trial.
Nevertheless, it is obvious that these studies are completely different and probably should not have
been combined for this outcome. Studies were included if they reported on the outcomes of neonatal.
Therefore, it is essential to adequately monitor the newborn and to identify early risk factors during
this period. Publication requirements for systematic reviews should be strengthened, following
currently existing guidelines and undergo a rigorous peer-review process that considers some of the
issues discussed previously. Interventions to improve rates of successful extubation in preterm
infants: a systematic review and meta-analysis. The objective of this study was to synthesize the
information from case reports of adverse water birth events to identify practices associated with
these outcomes, and to identify patterns of negative outcomes. Nasal masks or binasal prongs for
delivering continuous positive airway pressure in preterm neonates-a randomised trial. This is an
open-access article distributed under the terms of the Creative Commons Attribution License (CC
BY). This strongly suggests that this observed association probably occurred by chance and is not
related to the intervention. High-flow nasal cannulae in very preterm infants after extubation. Nasal
mask versus nasal prongs for delivering nasal continuous positive airway pressure in preterm infants
with respiratory distress: a randomized controlled trial. Surfactant administration via a thin
endotracheal catheter during spontaneous breathing in preterm infants: surfactant administration via
a thin endotracheal catheter. Nasal CPAP or intubation at birth for very preterm infants. The studies
should be combined only if they lack significant bias, if they answer the same specific question, if
they include similar populations, and if they attempt to compare similar interventions and measure
equivalent outcomes, so that a pooled effect of the results from individual studies yields a more
precise and representative estimate of the treatment effect ( 6 ). For more information, please refer to
our Privacy Policy. When one performs a systematic review, one forgoes the ability to conduct
logistic regression analysis using center effect as a variable. There were cases of unexplained
neonatal hyponatremia following water birth that need further investigation to determine the
mechanism that contributes to this complication. Descriptors: Nursing care; Newborn; Peripheral
catheterization; Vascular access devices; Evidence-Based Clinical Practice. Eligible manuscripts
reported any adverse neonatal outcome with immersion during labor or birth; or excluded if no
adverse outcome was reported or the birth reported was unattended. The problem arises when we try
to interpret combined results of studies that have, for instance, significant differences in the criteria
for intubation, especially if it is not defined a priori in the various studies included in the systematic
review. Third Edition. New York, NY: McGraw-Hill Education. (2015). Furthermore, their findings
do not apply at all to preterm infants below 25 weeks. Interventions to improve the use of systematic
reviews in decision-making by health system managers, policy makers and clinicians. Therefore,
heterogeneity between studies in a meta-analysis needs to be examined as much more than a simple
statistical test, and clearly, one more relevant issue when critically appraising a systematic review.
The research team conducted a systematic search for cases reports of poor neonatal outcomes with
water immersion. Drafting and revising the manuscript critically for important intellectual content. A
qualitative narrative synthesis was conducted to identify patterns in the reports. You can download
the paper by clicking the button above. Water immersion guidelines need to address infection risk,
optimal management of compromised water-born infants, and the potential association between
immersion practice and hyponatremia. FM and SD: substantial contribution to the analysis and
interpretation of the work. A total of five studies were identified and included in this. Randomized
trial of prongs or mask for nasal continuous positive airway pressure in preterm infants.
Drafting and revising the manuscript critically for important intellectual content. Most of us would
agree that almost any respiratory outcome in premature infants could be significantly influenced by
antenatal steroid exposure and gestational age. Should neonates less than 25 weeks’ gestation be
resuscitated. Furthermore, their findings do not apply at all to preterm infants below 25 weeks. For
this analysis, the I 2 statistic shows 0% heterogeneity, suggesting that the summary point estimate is
not biased by any relevant differences between the studies. Nasal masks or binasal prongs for
delivering continuous positive airway pressure in preterm neonates-a randomised trial. Thirty two
productions were included in this analysis. Enrollment of extremely low birth weight infants in a
clinical research study may not be representative. What is more promising is the fact that there is a
significant difference again in favor of the nasal mask interface with a reduction in moderate to
severe BPD, this time with moderate heterogeneity ( I 2 of 30%). Interventions to improve rates of
successful extubation in preterm infants: a systematic review and meta-analysis. The gestational age
of a preterm newborn is an important factor in determining the chances of survival and the necessity
for resuscitation. Binasal prong versus nasal mask for applying CPAP to preterm infants: a
randomized controlled trial. When we look at the pooled results for nasal CPAP failure within 72 h
after initiation, we see a marginally significant result in favor of nasal mask vs. To browse
Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade
your browser. An example of this point can be made in relation to a recently published systematic
review by King and colleagues ( 28 ). Results: Most of the studies were descriptive and cross-
sectional (50%), using peripheral venous catheter (62.5%). The years varied between 2006 and 2014.
Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures. Surfactant
administration via thin catheter during spontaneous breathing: randomized controlled trial. The
problem arises when we try to interpret combined results of studies that have, for instance,
significant differences in the criteria for intubation, especially if it is not defined a priori in the
various studies included in the systematic review. Any of the tests used for this purpose are only
providing information about differences between study results and telling us how likely the
differences in individual trial results are from chance alone ( 9 ). A recently published systematic
review by Wu et al. Should neonates less than 25 weeks’ gestation be resuscitated. The College at
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Comments Please sign in or register to post comments. If we exclude these two studies, the analysis
yields a significantly greater magnitude in the point estimate against using high flow nasal cannula as
the initial support strategy (1.72 vs. 1.57). Publication requirements for systematic reviews should be
strengthened, following currently existing guidelines and undergo a rigorous peer-review process
that considers some of the issues discussed previously. The research did, however, discover that the
majority of surviving. This strongly suggests that this observed association probably occurred by
chance and is not related to the intervention. This entails some assumptions about the studies
included in the analysis. Clinicians are sometimes confronted with systematic reviews that claim
results based on combining studies that differ in substantial ways and therefore yield conclusions that
are very difficult to interpret ( 6 ). In some cases, the studies found in the review process can be
combined using meta-analysis, so as to provide a single more precise estimate of the effect ( 3 ).