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. 2021 May 24;175(9):e210775. doi: 10.1001/jamapediatrics.2021.0775

Table 2. Certainty of Evidence for Different Comparisons for the Primary Outcomesa.

Comparison Indirect evidence Direct evidence Network meta-analysis
Certainty of evidence Certainty of evidence MD or RR (95% CrI) Certainty of evidence
Primary outcome: mean core body (axillary or rectal) temperature at admission or within first 2 h of life
PBWrTM:PCAP Lowb,c NA MD: 0.15 °C (−0.51 to 0.81 °C) Low
PBWrTM:PBWrHHGAS Lowb,c NA MD: 0.22 °C (−0.29 to 0.73 °C) Low
PBWrTM:PBWrPCAP Lowb,c NA MD: 0.36 °C (−0.09 to 0.79 °C) Low
PBWrTM:TM Lowb,c NA MD: 0.36 °C (−0.11 to 0.82 °C) Low
PBWrTM:INCUPBWr Lowb,c NA MD: 0.42 °C (−0.27 to 1.10 °C) Low
PBWrTM:PBWr NA Lowb,c MD: 0.42 °C (0.06 to 0.77 °C) Low
PBWrTM:RCARE Lowb,c NA MD: 0.98 °C (0.60 to 1.36 °C) Low
PCAP:PBWrHHGAS Lowd NA MD: 0.07 °C (−0.59 to 0.73 °C) Low
PCAP:PBWrPCAP Lowc,e NA MD: 0.21 °C (−0.39 to 0.80 °C) Low
PCAP:TM Lowf,g NA MD: 0.21 °C (−0.42 to 0.82 °C) Low
PCAP:INCUPBWr Lowd NA MD: 0.27 °C (−0.53 to 1.06 °C) Low
PCAP:PBWr Moderatec Lowd MD: 0.27 °C (−0.29 to 0.81 °C) Moderate
PCAP:RCARE Lowd Moderatec MD: 0.83 °C (0.28 to 1.38 °C) Moderate
PBWrHHGAS:PBWrPCAP Lowc,e NA MD: 0.14 °C (−0.31 to 0.58 °C) Low
PBWrHHGAS:TM Lowf,g NA MD: 0.14 °C (−0.34 to 0.60 °C) Low
PBWrHHGAS:INCUPBWr Lowd NA MD: 0.20 °C (−0.49 to 0.88 °C) Low
PBWrHHGAS:PBWr NA Moderatef,h MD: 0.20 °C (−0.17 to 0.56 °C) Moderate
PBWrHHGAS:RCARE Moderatef,h NA MD: 0.76 °C (0.38 to 1.15 °C) Moderate
PBWrPCAP:TM Lowc,e NA MD: 0.01 °C (−0.38 to 0.38 °C) Low
PBWrPCAP:INCUPBWr Lowc,e NA MD: 0.06 °C (−0.58 to 0.69 °C) Low
PBWrPCAP:PBWr Lowc,i,h Lowc,e MD: 0.06 °C (−0.20 to 0.32 °C) Low
PBWrPCAP:RCARE Lowc,i,h Lowc,i,h MD: 0.62 °C (0.37 to 0.88 °C) Low
TM:INCUPBWr Lowf,g NA MD: 0.05 °C (−0.59 to 0.71 °C) Low
TM:PBWr Moderatej,h Lowf,g MD: 0.06 °C (−0.23 to 0.36 °C) Moderate
TM:RCARE Lowf,g Moderatej,h MD: 0.62 °C (0.33 to 0.93 °C) Moderate
INCUPBWr:PBWr NA Lowd MD: 0.00 °C (−0.58 to 0.58 °C) Low
INCUPBWr:RCARE Lowd NA MD: 0.56 °C (−0.03 to 1.16 °C) Low
PBWr:RCARE Lowc,i,h Moderatek,h,l MD: 0.56 °C (0.44 to 0.69 °C) Moderate
Primary outcome: incidence of moderate to severe hypothermia (core body [axillary or rectal] temperature <36 °C) at admission or within first 2 h of life
SSC:PBWrHHGAS Lowc,m NA RR: 32.44 (0.01-51.67) Low
SSC:PBWrTM Lowc,m NA RR: 34.67 (0.00-39.26) Low
SSC:PBWrPCAP Very lowg,n,o NA RR: 3.16 (0.00-9.51) Very low
SSC:TM Lowc,m NA RR: 136.23 (0.01-153.95) Low
SSC:PBWr Lowc,m NA RR: 3.24 (0.01-9.85) Low
SSC:INCUPBWr Lowc,m NA RR: 8.95 (0.00-10.38) Low
SSC:RCARE NA Lowc,m RR: 0.29 (0.00-1.20) Low
PBWrHHGAS:PBWrTM Lown,p NA RR: 5.23 (0.02-12.02) Low
PBWrHHGAS:PBWrPCAP Very lowg,n,o NA RR: 0.67 (0.02-2.81) Very low
PBWrHHGAS:TM Lown,p NA RR: 74.08 (0.04-87.00) Low
PBWrHHGAS:PBWr NA Lown,p RR: 0.54 (0.05-2.01) Low
PBWrHHGAS:INCUPBWr Lown,p NA RR: 1.10 (0.00-3.35) Low
PBWrHHGAS:RCARE Lown,p NA RR: 0.12 (0.00-0.47) Low
PBWrTM:PBWrPCAP Very lowg,n,o NA RR: 3.40 (0.02-8.65) Very low
PBWrTM:TM Lown,q NA RR: 192.45 (0.05-228.44) Low
PBWrTM:PBWr NA Lown,q RR: 1.78 (0.05-7.20) Low
PBWrTM:INCUPBWr Lown,q NA RR: 6.24 (0.01-9.33) Low
PBWrTM:RCARE Lown,q NA RR: 0.43 (0.01-1.46) Low
PBWrPCAP:TM Lowr NA RR: 102.96 (0.22-277.98) Low
PBWrPCAP:PBWr Lowr Very lowg,n,o RR: 1.65 (0.27-5.91) Low
PBWrPCAP:INCUPBWr Very lowg,n,o NA RR: 3.57 (0.02-11.03) Very low
PBWrPCAP:RCARE Very lowg,n,o Lowr RR: 0.33 (0.04-1.05) Low
TM:PBWr Lowc,m Lows RR: 0.91 (0.01-4.60) Low
TM:INCUPBWr Lowc,m NA RR: 5.17 (0.00-5.45) Low
TM:RCARE Lows Lowc,m RR: 0.12 (0.00-0.62) Low
PBWr:INCUPBWr NA Lows RR: 1.39 (0.02-5.92) Low
PBWr:RCARE Lows Moderatec RR: 0.23 (0.04-0.55) Moderate
INCUPBWr:RCARE Lows NA RR: 2.27 (0.02-9.31) Low

Abbreviations: CrI, credible interval; INCUPBWr, plastic bag or wrap with incubator transport; MD, mean difference; NA, not available; PBWr, plastic bag or wrap; PBWrHHGAS, plastic bag or wrap with heated humidified respiratory gases; PBWrPCAP, plastic bag or wrap with plastic cap; PBWrTM, plastic bag or wrap with thermal mattress; PCAP, plastic cap; RCARE, routine care; RR, risk ratio; SSC, skin-to-skin contact; TM, thermal mattress.

a

The primary outcome was not downgraded for lack of blinding in any comparison because it was an objective outcome and blinding was difficult for these interventions.

b

Downgraded by 1 level for serious risk of bias because of 1 study32 in which 45% weight was quasi-randomized.

c

Downgraded by 1 level for serious imprecision because an optimal information size criterion was not met.

d

Downgraded by 2 levels for very serious imprecision because of small sample size and the CrI included no difference.

e

Downgraded by 1 level for serious risk of bias because of possible selection bias in 2 studies.33,54

f

Downgraded by 1 level for serious imprecision because the CrI included no difference.

g

Downgraded by 1 level for serious inconsistency because of heterogeneity.

h

Not downgraded for inconsistency because the heterogeneity was associated with differences between small and large beneficial outcomes.

i

Downgraded by 1 level for serious risk of bias because of possible selection bias in 2 studies.50,54

j

Downgraded by 1 level for serious risk of bias because of possible selection bias in 2 studies.25,28

k

Downgraded by 1 level for publication bias.

l

Not downgraded for risk of bias because the studies with possible risk of bias24,30,31,34,35,54 contributed only 27% weight, and 73% weight of effect estimate was from good-quality studies.

m

Downgraded by 1 level for serious risk of bias because of possible selection bias in the included study.26

n

Downgraded by 1 level for serious imprecision because the CrI reached no difference.

o

Downgraded by 1 level for serious risk of bias because of possible selection bias in 1 study.36

p

Not downgraded for heterogeneity because the heterogeneity was associated with the differences between small and large beneficial outcomes.

q

Downgraded by 1 level for serious risk of bias because of possible selection bias in the included study.32

r

Downgraded by 2 levels for very serious imprecision because of data from 1 study27 with a small sample size and risk benefit could not be decided.

s

Downgraded by 2 levels for very serious imprecision because of data from 1 study44 with a small sample size and risk benefit could not be decided.