Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in preterm infants: a network meta-analysis

Mitra, Souvik; Gardner, Courtney E; MacLellan, Abigale; Disher, Timothy; Styranko, Danielle M; Kuhle, Stefan; Johnston, Bradley C.; Dorling, Jon

doi:10.1002/14651858.cd013846

Cited by 3 publications

(7 citation statements)

References 61 publications

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“…Twenty-eight randomised controlled trials (RCTs) with 3999 infants were included 13. Nineteen RCTs (2877 infants) compared indomethacin versus placebo; 7 RCTs (914 infants) compared ibuprofen versus placebo; and 2 RCTs (208 infants) compared acetaminophen versus placebo.…”

Section: Resultsmentioning

confidence: 99%

“…A standard course of prophylactic indomethacin constituted a cumulative dosage of up to 0.6 mg/kg; prophylactic ibuprofen constituted a cumulative dosage of up to 20 mg/kg, while prophylactic acetaminophen constituted a cumulative dosage of up to 420 mg/kg. The detailed summary of findings (table 2) has been adapted from the study team’s 2022 Cochrane NMA 13…”

Section: Resultsmentioning

confidence: 99%

“…The following health outcomes were initially considered for the development of the guideline recommendations: severe IVH, mortality, NEC, gastrointestinal perforation, CLD, PDA ligation and neurodevelopmental impairment. Given that the evidence on neurodevelopmental impairment was available for only one drug, neurodevelopmental impairment was replaced by cerebral palsy when synthesising the evidence for benefits and harms 13. The total number of outcomes considered was limited to seven to avoid overwhelming the panel and to facilitate effective decision making 14.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, out of these seven outcomes, four (mortality, severe IVH, CLD and NEC) were chosen to be the most important for decision making by families in our cross-sectional study conducted to inform the guideline panel 12. Thresholds for benefit or harm for each outcome were defined a priori using a partially contextualised approach 13…”

Section: Methodsmentioning

confidence: 99%

“…None of the reviews provided direct comparisons between the three drugs. Therefore, for the purpose of the guideline development, a Cochrane network meta-analysis (NMA) was conducted de novo using standard Cochrane methods to compare the three COX-Is 13. Certainty of evidence was assessed using the GRADE guidance for NMA 18…”

Section: Methodsmentioning

confidence: 99%

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Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences

Mitra,

Whitehead,

Smith

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ImportanceProphylactic cyclo-oxygenase inhibitors (COX-Is) such as indomethacin, ibuprofen and acetaminophen may prevent morbidity and mortality in extremely preterm infants (born ≤28 weeks’ gestation). However, there is controversy around which COX-I, if any, is the most effective and safest, which has resulted in considerable variability in clinical practice. Our objective was to develop rigorous and transparent clinical practice guideline recommendations for the prophylactic use of COX-I drugs for the prevention of mortality and morbidity in extremely preterm infants. The Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework for multiple comparisons was used to develop the guideline recommendations. A 12-member panel, including 5 experienced neonatal care providers, 2 methods experts, 1 pharmacist, 2 parents of former extremely preterm infants and 2 adults born extremely preterm, was convened. A rating of the most important clinical outcomes was established a priori. Evidence from a Cochrane network meta-analysis and a cross-sectional mixed-methods study exploring family values and preferences were used as the primary sources of evidence. The panel recommended that prophylaxis with intravenous indomethacin may be considered in extremely preterm infants (conditional recommendation, moderate certainty in estimate of effects). Shared decision making with parents was encouraged to evaluate their values and preferences prior to therapy. The panel recommended against routine use of ibuprofen prophylaxis in this gestational age group (conditional recommendation, low certainty in the estimate of effects). The panel strongly recommended against use of prophylactic acetaminophen (strong recommendation, very low certainty in estimate of effects) until further research evidence is available.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences

Mitra,

Whitehead,

Smith

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in preterm infants: a network meta-analysis

Mitra

Gardner

MacLellan

et al. 2022

Cochrane Database of Systematic Reviews

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The Impact of Preoperative and Postoperative Nutritional Interventions on Treatment Outcomes and Quality of Life in Colorectal Cancer Patients—A Comprehensive Review

Piekarska,

Prusisz,

Włodarczyk

et al. 2024

Medicina

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Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, with high morbidity and mortality rates. Nutritional status has emerged as a significant factor influencing the prognosis and survival of CRC patients. This comprehensive literature review examines the role of nutritional support in improving treatment outcomes, including the efficacy of interventions, patient quality of life (QoL), and the modulation of inflammatory responses. The findings suggest that tailored nutritional interventions improve clinical outcomes, enhance QoL, and reduce treatment-related complications, particularly by attenuating inflammation. Furthermore, the review highlights the cost-effectiveness of nutritional strategies and identifies key methods to enhance patient compliance with dietary recommendations. In conclusion, integrating nutritional support into CRC treatment plans is crucial for optimizing clinical management and improving patient well-being.

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Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in preterm infants: a network meta-analysis

Cited by 3 publications

References 61 publications

Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences

Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in extremely preterm infants: a clinical practice guideline incorporating family values and preferences

Prophylactic cyclo-oxygenase inhibitor drugs for the prevention of morbidity and mortality in preterm infants: a network meta-analysis

The Impact of Preoperative and Postoperative Nutritional Interventions on Treatment Outcomes and Quality of Life in Colorectal Cancer Patients—A Comprehensive Review

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