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. 2026 Jun 10;17:1823729. doi: 10.3389/fphar.2026.1823729

FIGURE 2.

Flowchart illustrating a systematic review process: 273 records identified, 34 duplicates removed, 239 records screened, 107 excluded due to criteria including non-relevance to aminoglycoside ototoxicity, non-pediatric focus, or insufficient methodological detail, resulting in 132 studies included in qualitative synthesis.

Adapted literature search and study selection workflow. A total of 273 records were identified through database searching of PubMed, EMBASE, Cochrane Library, Web of Science, and CINAHL, and imported into EndNote reference management software. Duplicate records were removed (n = 34), and the remaining records (n = 239) were screened by title and abstract followed by iterative full-text review. Records were excluded if they did not address aminoglycoside-associated ototoxicity, lacked relevance to pediatric or neonatal populations, did not include clinically or mechanistically relevant outcomes, had insufficient methodological detail to support inclusion, or were non-primary reports (editorials or conference abstracts). A total of 132 studies were included in the final qualitative synthesis. Because this review was conducted as a structured narrative review, screening and eligibility assessment were not conducted as discrete, prospectively recorded stages; accordingly, stage-specific record counts are not reported and the diagram reflects the overall selection process rather than sequential PRISMA-compliant stages. Record counts are reported for transparency rather than as reproducible PRISMA-compliant outputs. Exclusion reasons are presented as categories without individual counts, consistent with the iterative methodology described in the Literature Search Strategy section. Figure adapted from the PRISMA 2020 framework (Page et al., 2021).