Summary of findings for the main comparison. Prone compared with supine for newborn ventilated.
| Prone compared with supine for newborn ventilated | ||||||
| Patient or population: neonates with mechanical ventilation Settings: neonatal intensive care units Intervention: prone Comparison: supine | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative risk | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Supine | Prone | |||||
| Death (neonatal or infant) ‐ not reported | No data reported for this outcome | |||||
| Long‐term complications (neurodevelopmental) | No data reported for this outcome | |||||
| Long‐term complications (bronchopulmonary dysplasia, chronic lung disease) | No data reported for this outcome | |||||
| Short‐term complications (respiratory) | No data reported for this outcome | |||||
| Short‐term complications (procedural) | No data reported for this outcome | |||||
| Periventricular or intraventricular haemorrhage | No data reported for this outcome | |||||
| Oxygenation: PO2 (mmHg)a | Mean PO2 ranged across control groups from 51.39 to 73.05 mmHg. | Mean PO2 (mmHg) in intervention groups was 5.49 higher (2.92 to 8.05 higher). | 116 (3 studies)b | ⊕⊕⊕⊝ moderatec,d | Changes in PO2 greater than 2 mmHg are clinically relevant. | |
| Oxygenation: SpO2e | Mean SpO2 in control groups was 89.7% to 97.1%. | Mean SpO2 in intervention groups was 2.18 higher (1.13 to 3.24 higher). | 308 (9 studies)f | ⊕⊝⊝⊝ very lowd,g,h | Changes in SpO2 lower than 2% are not clinically relevant. | |
| SpO2 at ‐ sensitivity low risk; selection bias | Mean SpO2 in control groups was 94.9% to 97.1%. | Mean SpO2 in intervention groups was 0.64 higher (0.26 to 1.02 higher). | 92 (4 studies)i | ⊕⊕⊕⊝ moderatej | Changes in SpO2 lower than 2% are not clinically relevant. | |
| Desaturations | Mean desaturations in control groups ranged from 42.1% to 50%. | Mean desaturations in intervention groups ranged from 4.76% to 26.3%. | Odds ratio 0.11 (0.04 to 0.31) | 178 (3 studies)k | ⊕⊕⊝⊝ lowl,m | |
| *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. | ||||||
| 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. | ||||||
aPO2 (mmHg) = arterial oxygen tension.
bCountries: Australia, Canada and China. Design: two cross‐over, one parallel. Years: 1990; 2013; 2015.
cNo limitations due to methodological concerns. Blinding for participants and personnel is not possible, but for this outcome, this is not considered a source of bias. dDowngrade due to imprecision resulting from a small number of participants.
e SpO2 = haemoglobin oxygen saturation.
fCountries: Australia, Brazil, EEUU, France, Japan and Taiwan. Design: all cross‐over. Years: 1991; 1992; 1995; 1999; 2003; 2012; 2013; 2013; 2013. gDowngraded owing to methodological concerns caused by risk of selection bias in the studies.
hDowngraded owing to inconsistency caused by very high heterogeneity: I² = 89%.
iCountries: Australia, Brazil and Taiwan. Design: all cross‐over. Years: 2002; 2012M; 2013; 2013.
jDowngraded owing to imprecision, because the confidence interval for the estimated effect crosses the threshold of clinical relevance.
kCountries: Brazil, France and Taiwan. Design: two cross‐over, one parallel. Years: 2002; 2003; 2013. lDowngraded owing to inconsistency, because variations in the definition of the outcome across studies limit their comparability.
mDowngraded owing to imprecision, because the confidence interval for the estimated effect crosses the threshold of clinical relevance.