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.
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.
Downgraded by 1 level for serious risk of bias because of 1 study32 in which 45% weight was quasi-randomized.
Downgraded by 1 level for serious imprecision because an optimal information size criterion was not met.
Downgraded by 2 levels for very serious imprecision because of small sample size and the CrI included no difference.
Downgraded by 1 level for serious risk of bias because of possible selection bias in 2 studies.33,54
Downgraded by 1 level for serious imprecision because the CrI included no difference.
Downgraded by 1 level for serious inconsistency because of heterogeneity.
Not downgraded for inconsistency because the heterogeneity was associated with differences between small and large beneficial outcomes.
Downgraded by 1 level for serious risk of bias because of possible selection bias in 2 studies.50,54
Downgraded by 1 level for serious risk of bias because of possible selection bias in 2 studies.25,28
Downgraded by 1 level for publication bias.
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.
Downgraded by 1 level for serious risk of bias because of possible selection bias in the included study.26
Downgraded by 1 level for serious imprecision because the CrI reached no difference.
Downgraded by 1 level for serious risk of bias because of possible selection bias in 1 study.36
Not downgraded for heterogeneity because the heterogeneity was associated with the differences between small and large beneficial outcomes.
Downgraded by 1 level for serious risk of bias because of possible selection bias in the included study.32
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.
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.