{"title":"新生儿科学的证据确定性——Cochrane综述的荟萃流行病学分析。","authors":"Tuomas Varrio, Daniele De Luca, Ilari Kuitunen","doi":"10.1007/s00431-025-06023-w","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p><p><strong>Conclusion: </strong>In 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.</p><p><strong>What is known: </strong>• 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.</p><p><strong>What is new: </strong>• 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.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"191"},"PeriodicalIF":2.9000,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11814034/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evidence certainty in neonatology-a meta-epidemiological analysis of Cochrane reviews.\",\"authors\":\"Tuomas Varrio, Daniele De Luca, Ilari Kuitunen\",\"doi\":\"10.1007/s00431-025-06023-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p><p><strong>Conclusion: </strong>In 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.</p><p><strong>What is known: </strong>• 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.</p><p><strong>What is new: </strong>• 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.</p>\",\"PeriodicalId\":11997,\"journal\":{\"name\":\"European Journal of Pediatrics\",\"volume\":\"184 2\",\"pages\":\"191\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-02-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11814034/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00431-025-06023-w\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00431-025-06023-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Evidence certainty in neonatology-a meta-epidemiological analysis of Cochrane reviews.
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.
Conclusion: In 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.
期刊介绍：
The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics.
EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned.
The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics.
EJPE is active on social media (@EurJPediatrics) and we invite you to participate.
EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.
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