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. 2023 Apr 11;2023(4):CD013873. doi: 10.1002/14651858.CD013873.pub2

Comparison 1. High‐ versus standard‐dose strategies for any indication.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1.1 All‐cause mortality prior to hospital discharge 5 723 Risk Ratio (M‐H, Fixed, 95% CI) 0.86 [0.53, 1.38]
1.1.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 4 559 Risk Ratio (M‐H, Fixed, 95% CI) 0.92 [0.52, 1.63]
1.1.2 Standard‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 164 Risk Ratio (M‐H, Fixed, 95% CI) 0.73 [0.31, 1.71]
1.2 Major neurodevelopmental disability in children aged three to five years 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.2.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.3 Failure to extubate within one week of commencing treatment 4   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.3.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 4 521 Risk Ratio (M‐H, Fixed, 95% CI) 0.54 [0.40, 0.73]
1.4 Reintubation within one week of commencing treatment 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.4.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 238 Risk Ratio (M‐H, Fixed, 95% CI) 0.36 [0.19, 0.71]
1.5 Apnea: number of infants with at least one episode (defined as interruption of breathing for more than 20 seconds) after 24 hours from commencing treatment, in a 24‐hour period and over one week 1 78 Risk Ratio (M‐H, Fixed, 95% CI) 1.01 [0.59, 1.75]
1.5.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 78 Risk Ratio (M‐H, Fixed, 95% CI) 1.01 [0.59, 1.75]
1.6 Side effects (tachycardia, agitation, or feed intolerance) leading to a reduction in dose or withholding of caffeine 5   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.6.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 5 593 Risk Ratio (M‐H, Fixed, 95% CI) 1.66 [0.86, 3.23]
1.7 Bronchopulmonary dysplasia/chronic lung disease: 28 days of oxygen exposure  1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.8 Bronchopulmonary dysplasia/chronic lung disease at 36 weeks' postmenstrual age 5 723 Risk Ratio (M‐H, Fixed, 95% CI) 0.75 [0.60, 0.94]
1.8.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 4 559 Risk Ratio (M‐H, Fixed, 95% CI) 0.76 [0.60, 0.97]
1.8.2 Standard‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 164 Risk Ratio (M‐H, Fixed, 95% CI) 0.68 [0.36, 1.29]
1.9 Number of days using mechanical ventilation 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
1.9.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 2 201 Mean Difference (IV, Fixed, 95% CI) 0.01 [‐0.85, 0.87]
1.10 Intraventricular hemorrhage, any grade 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.10.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 2 361 Risk Ratio (M‐H, Fixed, 95% CI) 0.90 [0.63, 1.27]
1.11 Intraventricular hemorrhage, grade 3 to 4 5   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.11.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 5 686 Risk Ratio (M‐H, Fixed, 95% CI) 1.26 [0.67, 2.36]
1.12 Cerebellar hemorrhage at brain ultrasound (yes/no) 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.12.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 74 Risk Ratio (M‐H, Fixed, 95% CI) 3.33 [1.00, 11.15]
1.13 Magnetic resonance imaging (MRI) abnormalities at term equivalent age (yes/no), defined as white matter lesions (i.e. cavitations [Rutherford 2010]) and punctate lesions (Cornette 2002); germinal matrix‐intraventricular hemorrhage (Parodi 2015); or cerebellar hemorrhage (Limperopoulos 2007) 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.13.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 74 Risk Ratio (M‐H, Fixed, 95% CI) 0.50 [0.10, 2.56]
1.14 Periventricular leukomalacia 3 272 Risk Difference (M‐H, Fixed, 95% CI) 0.02 [‐0.04, 0.08]
1.14.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 3 272 Risk Difference (M‐H, Fixed, 95% CI) 0.02 [‐0.04, 0.08]
1.15 Necrotizing enterocolitis (proven = Bell stage of 2 or greater) (Bell 1978) 5   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.15.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 5 637 Risk Ratio (M‐H, Fixed, 95% CI) 0.80 [0.43, 1.51]
1.16 Patent ductus arteriosus (PDA) requiring treatment (cyclo‐oxygenase inhibitors or surgical ligation) 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.16.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 2 201 Risk Ratio (M‐H, Fixed, 95% CI) 0.87 [0.59, 1.27]
1.17 Retinopathy of prematurity (ROP) (any ROP) (International Committee 2005) 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.17.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 2 365 Risk Ratio (M‐H, Fixed, 95% CI) 0.85 [0.56, 1.29]
1.18 Retinopathy of prematurity (ROP) (severe ROP [stage 3 or greater]) (International Committee 2005) 3   Risk Difference (M‐H, Fixed, 95% CI) Subtotals only
1.18.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 3 481 Risk Difference (M‐H, Fixed, 95% CI) ‐0.03 [‐0.07, 0.01]
1.19 Seizures (clinically diagnosed; diagnosed by electroencephalography) 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.19.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1 74 Risk Ratio (M‐H, Fixed, 95% CI) 1.42 [0.79, 2.53]
1.20 Developmental delay (Bayley Mental Developmental Index or Griffiths Mental Development Scale in children aged 18 to 24 months  1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.20.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.21 Bayley‐III cognitive score in children at 18 to 24 months CA 1 42 Mean Difference (IV, Fixed, 95% CI) ‐1.90 [‐8.60, 4.80]
1.22 Cerebral palsy in children aged 18 to 24 months  1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.22.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.23 Blindness in children aged 18 to 24 months  1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.23.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.24 Deafness in children aged 18 to 24 months  1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
1.24.1 High‐loading and high‐maintenance dose versus standard‐loading and standard‐maintenance dose 1   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected