Journal of Neonatal Biology

Abstract

Systematic Cochrane Reviews in Neonatology: A Critical Appraisal

Christiane Willhelm, Wolfgang Girisch, Sven Gottschling, Stefan Gräber and Sascha Meyer

Background: There is a lack of up-to-date, systematic reviews that critically assess the role and potential limitations
of Evidence based medicine (EBM) and systematic reviews in neonatology.
Methods: We performed a systematic literature review of all Cochrane Reviews published between 1996 and 2010
by the Cochrane Neonatal Review Group (CNRG). Main outcome parameter: Assessment of the percentage of reviews
that concluded that a certain intervention provides a benefit, percentage of reviews that concluded that no benefit was
seen, and percentage of studies that concluded that the current level of evidence is inconclusive.
Results: In total, 262 reviews were enrolled, most of which included exclusively preterm infants (146/262). The
majority of reviews assessed pharmacological interventions (145/262); other important fields included nutritional
(46/262), and ventilatory issues (27/262). In 42/262 reviews a clear recommendation in favor of a certain interventions
was given, while 98/262 reviews concluded that certain interventions should not be performed. However, the largest
proportion of reviews was inconclusive (122/262), and did not issue specific recommendations. The proportion of
inconclusive reviews increased from 30% (1996-2000), to 50% (2001-2005), and finally to 58% for the years 2006-
2010. Common reasons for inconclusive reviews were small number of patients (105), insufficient data (94), insufficient
methodological quality (87), and heterogeneity of studies (69).
Conclusions: There is an ongoing need for high quality research in order to reduce the proportion of inconclusive
meta-analyses in the field of neonatology. Funding and research agencies will play a vital role in selecting the most
appropriate research programs.