. 2023 Jun 20;2023(6):CD004205. doi: 10.1002/14651858.CD004205.pub4

Summary of findings 1. Pentoxifylline with antibiotics (any dose or duration) compared to placebo or no intervention for neonatal sepsis.

Pentoxifylline with antibiotics (any dose or duration) compared to placebo with antibiotics or antibiotics alone for neonatal sepsis
Patient or population: neonates with sepsis Settings: neonatal intensive care unit Intervention: PTX Comparison: placebo
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Placebo	PTX
All‐cause mortality during hospital stay	36/207	20/209	RR 0.57 (0.35, 0.93)	416 participants (6 studies)	⊕⊕⊝⊝ Low^a
Chronic lung disease	4/60	6/60	RR 1.50 (0.45, 5.05)	120 participants (1 study)	⊕⊝⊝⊝ Very low^b
Severe intraventricular haemorrhage	8/60	6/60	RR 0.75 (0.28, 2.03)	120 participants (1 study)	⊕⊝⊝⊝ Very low^b
Periventricular leukomalacia	4/60	2/60	RR 0.50 (0.10, 2.63)	120 participants (1 study)	⊕⊝⊝⊝ Very low^b
Length of hospital stay (LOS) in days	The mean LOS ranged across control groups from 33.8 to 38.3 days.	The mean LOS in the intervention groups was 22.6 to 31.3 days.	Mean difference −7.74, 95% CI −11.72, −3.76	157 participants (2 studies)	⊕⊕⊝⊝ Low^c
Necrotising enterocolitis, any Bell stage	13/203	23/202	RR 0.56 (0.29, 1.06)	405 participants (6 studies)	⊕⊝⊝⊝ Very low^d
Retinopathy of prematurity, any stage	5/60	2/60	RR 0.40 (0.08, 1.98)	120 participants (1 study)	⊕⊝⊝⊝ Very low^b
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; PTX: pentoxifylline; RR: risk ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aDowngraded to low because four studies had a high risk of bias, and the summary estimate was imprecise with wide CIs.

^bDowngraded to very low because there was only one included study and due to imprecision of the summary estimate.

^cDowngraded to low because there were only two included studies, one of which had a high risk of bias.

^dDowngraded to very low because three studies had a high risk of bias, and the summary estimate was imprecise with wide CIs.