Summary of findings for the main comparison. Adjunctive steroid versus placebo for reducing death in neonatal bacterial meningitis.
| Adjunctive steroid versus placebo for reducing death in neonatal bacterial meningitis | ||||||
| Patient or population: neonates with clinical and microbiological features of bacterial meningitis Settings: neonatal care facilities in both developed and developing countries Intervention: adjunctive steroid versus placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Adjunctive steroid vs placebo | |||||
| All‐cause death until hospital discharge | Study population | RR 0.46 (0.24 to 0.88) | 132 (2 studies) | ⊕⊝⊝⊝ very lowa‐e |
Daoud 1999 was a quasi‐randomised trial. Mathur 2013 was an open trial The direction of effect was different in the 2 studies Concern has been expressed regarding imprecision, as both trials enrolled few infants |
|
| 354 per 1000 | 163 per 1000 (85 to 312) | |||||
| Medium‐risk population | ||||||
| 340 per 1000 | 156 per 1000 (82 to 299) | |||||
| Number of participants with developmental delay | Study population | RR 0.77 (0.32 to 1.87) | 38 (1 study) | ⊕⊕⊝⊝ lowa,d | Daoud 1999 was a quasi‐randomised trial | |
| 389 per 1000 | 300 per 1000 (124 to 727) | |||||
| Medium‐risk population | ||||||
| 389 per 1000 | 300 per 1000 (124 to 727) | |||||
| Hearing loss at 2 years of age | Study population | RR 1.8 (0.18 to 18.21) | 38 (1 study) | ⊕⊕⊝⊝ lowa,d |
Daoud 1999 was a quasi‐randomised trial Concern has been expressed regarding imprecision, as Daoud 1999 enrolled only 52 infants |
|
| 56 per 1000 | 101 per 1000 (10 to 1000) | |||||
| Medium‐risk population | ||||||
| 56 per 1000 | 101 per 1000 (10 to 1000) | |||||
| Hearing loss at 4 to 10 weeks after discharge | Study population | RR 0.41 (0.17 to 0.98) | 59 (1 study) | ⊕⊕⊝⊝ lowb,e,f |
Mathur 2013 was an open trial, and duration of follow‐up was rather short Concern has been expressed regarding imprecision, as Mathur 2013 enrolled only 80 infants |
|
| 417 per 1000 | 171 per 1000 (71 to 409) | |||||
| Medium‐risk population | ||||||
| 417 per 1000 | 171 per 1000 (71 to 409) | |||||
| *The basis for the assumed risk (e.g. 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; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate | ||||||
aDaoud 1999 was a quasi‐randomised trial.
bMathur 2013 was an open trial. cThe direction of effect was different in the two studies.
dConcern has been expressed regarding imprecision, as Daoud 1999 enrolled only 52 infants.
eConcern has been expressed regarding imprecision, as Mathur 2013 enrolled only 80 infants.
fIn Mathur 2013, the duration of follow‐up was rather short.