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

Table 2. Certainty of Evidence for Different Comparisons for the Primary Outcomes^a.

Comparison	Indirect evidence	Direct evidence	Network meta-analysis
Comparison	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	Low^b^,^c	NA	MD: 0.15 °C (−0.51 to 0.81 °C)	Low
PBWrTM:PBWrHHGAS	Low^b^,^c	NA	MD: 0.22 °C (−0.29 to 0.73 °C)	Low
PBWrTM:PBWrPCAP	Low^b^,^c	NA	MD: 0.36 °C (−0.09 to 0.79 °C)	Low
PBWrTM:TM	Low^b^,^c	NA	MD: 0.36 °C (−0.11 to 0.82 °C)	Low
PBWrTM:INCUPBWr	Low^b^,^c	NA	MD: 0.42 °C (−0.27 to 1.10 °C)	Low
PBWrTM:PBWr	NA	Low^b^,^c	MD: 0.42 °C (0.06 to 0.77 °C)	Low
PBWrTM:RCARE	Low^b^,^c	NA	MD: 0.98 °C (0.60 to 1.36 °C)	Low
PCAP:PBWrHHGAS	Low^d	NA	MD: 0.07 °C (−0.59 to 0.73 °C)	Low
PCAP:PBWrPCAP	Low^c^,^e	NA	MD: 0.21 °C (−0.39 to 0.80 °C)	Low
PCAP:TM	Low^f^,^g	NA	MD: 0.21 °C (−0.42 to 0.82 °C)	Low
PCAP:INCUPBWr	Low^d	NA	MD: 0.27 °C (−0.53 to 1.06 °C)	Low
PCAP:PBWr	Moderate^c	Low^d	MD: 0.27 °C (−0.29 to 0.81 °C)	Moderate
PCAP:RCARE	Low^d	Moderate^c	MD: 0.83 °C (0.28 to 1.38 °C)	Moderate
PBWrHHGAS:PBWrPCAP	Low^c^,^e	NA	MD: 0.14 °C (−0.31 to 0.58 °C)	Low
PBWrHHGAS:TM	Low^f^,^g	NA	MD: 0.14 °C (−0.34 to 0.60 °C)	Low
PBWrHHGAS:INCUPBWr	Low^d	NA	MD: 0.20 °C (−0.49 to 0.88 °C)	Low
PBWrHHGAS:PBWr	NA	Moderate^f^,^h	MD: 0.20 °C (−0.17 to 0.56 °C)	Moderate
PBWrHHGAS:RCARE	Moderate^f^,^h	NA	MD: 0.76 °C (0.38 to 1.15 °C)	Moderate
PBWrPCAP:TM	Low^c^,^e	NA	MD: 0.01 °C (−0.38 to 0.38 °C)	Low
PBWrPCAP:INCUPBWr	Low^c^,^e	NA	MD: 0.06 °C (−0.58 to 0.69 °C)	Low
PBWrPCAP:PBWr	Low^c^,ⁱ^,^h	Low^c^,^e	MD: 0.06 °C (−0.20 to 0.32 °C)	Low
PBWrPCAP:RCARE	Low^c^,ⁱ^,^h	Low^c^,ⁱ^,^h	MD: 0.62 °C (0.37 to 0.88 °C)	Low
TM:INCUPBWr	Low^f^,^g	NA	MD: 0.05 °C (−0.59 to 0.71 °C)	Low
TM:PBWr	Moderate^j^,^h	Low^f^,^g	MD: 0.06 °C (−0.23 to 0.36 °C)	Moderate
TM:RCARE	Low^f^,^g	Moderate^j^,^h	MD: 0.62 °C (0.33 to 0.93 °C)	Moderate
INCUPBWr:PBWr	NA	Low^d	MD: 0.00 °C (−0.58 to 0.58 °C)	Low
INCUPBWr:RCARE	Low^d	NA	MD: 0.56 °C (−0.03 to 1.16 °C)	Low
PBWr:RCARE	Low^c^,ⁱ^,^h	Moderate^k^,^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	Low^c^,^m	NA	RR: 32.44 (0.01-51.67)	Low
SSC:PBWrTM	Low^c^,^m	NA	RR: 34.67 (0.00-39.26)	Low
SSC:PBWrPCAP	Very low^g^,ⁿ^,^o	NA	RR: 3.16 (0.00-9.51)	Very low
SSC:TM	Low^c^,^m	NA	RR: 136.23 (0.01-153.95)	Low
SSC:PBWr	Low^c^,^m	NA	RR: 3.24 (0.01-9.85)	Low
SSC:INCUPBWr	Low^c^,^m	NA	RR: 8.95 (0.00-10.38)	Low
SSC:RCARE	NA	Low^c^,^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 low^g^,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 low^g^,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	Low^r	NA	RR: 102.96 (0.22-277.98)	Low
PBWrPCAP:PBWr	Low^r	Very low^g^,ⁿ^,^o	RR: 1.65 (0.27-5.91)	Low
PBWrPCAP:INCUPBWr	Very low^g^,ⁿ^,^o	NA	RR: 3.57 (0.02-11.03)	Very low
PBWrPCAP:RCARE	Very low^g^,ⁿ^,^o	Low^r	RR: 0.33 (0.04-1.05)	Low
TM:PBWr	Low^c^,^m	Low^s	RR: 0.91 (0.01-4.60)	Low
TM:INCUPBWr	Low^c^,^m	NA	RR: 5.17 (0.00-5.45)	Low
TM:RCARE	Low^s	Low^c^,^m	RR: 0.12 (0.00-0.62)	Low
PBWr:INCUPBWr	NA	Low^s	RR: 1.39 (0.02-5.92)	Low
PBWr:RCARE	Low^s	Moderate^c	RR: 0.23 (0.04-0.55)	Moderate
INCUPBWr:RCARE	Low^s	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 bias^{24,30,31,34,35,54} 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.

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

Table 2. Certainty of Evidence for Different Comparisons for the Primary Outcomes^a.