Summary of findings for the main comparison.

Supine midline head position with the bed at 0° versus supine head rotated 90° with the bed at 0° for preventing occurrence or extension of germinal matrix‐intraventricular hemorrhage in preterm infants

Supine midline head position with the bed at 0° versus supine head rotated 90° with the bed at 0° for preventing occurrence or extension of germinal matrix‐intraventricular hemorrhage in preterm infants
Patient or population: very preterm infants (i.e., ≤ 32 weeks' gestational age) of any birth weight Setting: neonatal intensive care units (included trials conducted in Saudi Arabia) Intervention: supine midline head position with the bed at 0° Comparison: supine head rotated 90° with the bed at 0°
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Supine midline head position with the bed at 0° vs supine head rotated 90° with the bed at 0°
Intraventricular hemorrhage, any grade	High‐risk population		RR 1.14 (0.55 to 2.35)	110 (2 studies)	⊕⊕⊝⊝ low	High risk for performance bias in both included trials, although blinding for outcome assessors was provided; unclear risk for selection and reporting bias in Al‐Abdi 2015 and Al‐Abdi 2011, respectively. Downgraded by one level Precision: lack of precision due to small sample size and wide CIs. Downgraded by one level Indirectness: trials conducted in the target population
	197 per 1000	225 per 1000 (108 to 463)
Intraventricular hemorrhage, grade 3 to 4	High‐risk population		RR 1.57 (0.28 to 8.98)	110 (2 studies)	⊕⊝⊝⊝ very low	High risk for performance bias in both included trials, although blinding for outcome assessors was provided; unclear risk for selection and reporting bias in Al‐Abdi 2015 and Al‐Abdi 2011, respectively. Downgraded by one level Precision: lack of precision due to small sample size, few events and wide CIs. Downgraded by two levels Indirectness: trials conducted in the target population
	36 per 1000	57 per 1000 (10 to 323)
Neonatal mortality	High‐risk population		RR 0.52 (0.16 to 1.65)	110 (2 studies)	⊕⊕⊝⊝ low	High risk for performance bias in both included trials; unclear risk for selection and reporting bias in Al‐Abdi 2015 and Al‐Abdi 2011, respectively. Downgraded by one level Precision: lack of precision due to small sample size and wide CIs. Downgraded by one level Indirectness: trials conducted in the target population
	148 per 1000	77 per 1000 (24 to 244)
*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 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

None of the included trials reported on the other outcomes that we planned to present in this table (i.e., cerebellar hemorrhage on brain ultrasound; retinopathy of prematurity; long‐term neurodevelopmental outcome; and major neurodevelopmental disability).