Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 6 appraisals
Journal of perinatal medicine
Early kangaroo care in preterm ≤32 weeks and very low birth weight infants: a systematic review and meta-analysis
OBJECTIVES: Kangaroo care (KC), involving skin-to-skin contact, early breastfeeding and early discharge, demonstrated benefits in improving outcomes for preterm and low birth weight infants. This systematic review and meta-analysis aimed to evaluate the effectiveness of early KC (initiated within the first 24 h) vs. conventional neonatal care in very preterm infants (≤32 weeks) and/or very low birth weight (VLBW) infants (<1,500 g). METHODS: A comprehensive search of MEDLINE, SCOPUS, Web of Science, and CENTRAL databases was conducted. Randomized controlled trials (RCTs) comparing early KC to conventional care in very preterm and/or VLBW infants were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted using R, with relative risks (RR) and 95 % confidence intervals (CI) calculated. RESULTS: Four RCTs, encompassing 1,679 newborns, were included. Meta-analysis revealed a significant reduction in mortality risk (RR=0.81, 95 % CI: 0.67-0.98) with early KC. The pooled RR for infection risk was 0.89 (95 % CI: 0.77-1.02). The impact on hypothermia was mixed, with moderate heterogeneity observed. CONCLUSIONS: Early KC may reduce mortality and morbidity in very preterm and VLBW infants although its effects on hypothermia vary by severity. Further studies are required to assess its effects on infants weighing <1,000 g or born before 28 weeks of gestation.
26 May 2026
Read appraisal →Journal of neonatal-perinatal medicine
Machine learning demonstrates normal fetal Doppler velocimetry associated with reduced risk of necrotizing enterocolitis among preterm infants with growth restriction
BackgroundNecrotizing enterocolitis (NEC) is an intestinal ischemic disease that affects preterm infants with fetal growth restriction (FGR). The role of fetal Dopplers in stratifying risk for developing NEC is unclear but the innovative use of machine learning technology may aid in identifying their contribution.MethodsThis is a single center retrospective cohort of 164 infants born before 33 weeks' gestation with FGR from 2016 to 2019. We used machine learning to classify NEC and to evaluate the predictive values of gestational age (GA), birth weight (BW), and the presence of abnormal umbilical artery (UA) Dopplers before delivery.ResultsEarly GA and lower BW strongly predicted NEC. The presence of normal fetal UA Dopplers was heavily weighted in classifying infants unlikely to develop NEC. Fetal UA Dopplers had a 95% specificity (15% sensitivity) for NEC.ConclusionsIf validated, normal fetal UA Doppler studies may identify infants with FGR at low risk for NEC who may avoid conservative NEC-prevention strategies.
9 May 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial
OBJECTIVE: To assess the economic consequences of initiating full milk feeds from birth compared with intravenous fluids with gradual feeding in infants born preterm. DESIGN: Within-trial economic evaluation alongside a prospective, multicentre, randomised controlled trial (Fluids Exclusively Enteral from Day 1). A cost-consequence approach was used (revised from the planned cost-effectiveness analysis to avoid double counting length of stay within costs). SETTING: 46 UK National Health Service (NHS) neonatal units. PATIENTS: Preterm infants born at 30+0to 32+6 weeks' gestation. INTERVENTIONS: Infants were allocated to either full milk feeds or gradual feeding with intravenous support within 3 hours of birth. MAIN OUTCOME MEASURE: Resource use and costs were captured from birth to 6 weeks' corrected age. Costs were assessed from an NHS and personal social services perspective. The primary clinical outcome was length of hospital stay. RESULTS: 2088 infants were enrolled. There was no statistically significant difference in mean (95% CI) length of hospital stay between groups (-0.050 days (-0.638 to 0.538)). Mean total costs were £670 lower in the full milk group (95% CI: -£1562 to £223; p=0.141). Subgroup analyses suggested lower costs among infants born at 30 weeks' gestation and those below the 10th birth weight centile; no evidence of interaction was found. CONCLUSIONS: Initiating full milk feeds from birth was associated with a modest reduction in costs compared with gradual feeding. While overall hospital stays and costs were not significantly reduced, early full feeding may offer economic advantages in selected subgroups. Further research is needed to assess long-term outcomes. TRIAL REGISTRATION NUMBER: ISRCTN89654042.
19 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Umbilical cord management strategies and risk of intraventricular haemorrhage in preterm neonates: a systematic review and meta-analysis
OBJECTIVES: To assess the comparative effectiveness of different umbilical cord management strategies for preventing intraventricular haemorrhage (IVH) in preterm neonates. DESIGN: A systematic review and meta-analysis. STUDY SOURCES: PubMed, Scopus and Web of Science were searched from inception to March 2025 for relevant randomised controlled trials. PARTICIPANTS: All preterm neonates born <37+0 weeks of gestation. INTERVENTIONS: All umbilical cord management strategies, including immediate cord clamping (ICC), delayed cord clamping (DCC), intact umbilical cord milking (I-UCM), cut umbilical cord milking (C-UCM), intact cord stabilisation (ICS), physiology-based cord clamping and extrauterine placental perfusion. MAIN OUTCOME MEASURES: Any grade IVH (grades I-IV) and severe IVH (grades III-IV). DATA SYNTHESIS: Random-effects meta-analyses were conducted to calculate risk ratios (RRs) with 95% CIs. Analyses were stratified for very preterm (<32 weeks) and extremely preterm neonates (<28 weeks). RESULTS: Forty-nine studies with 8706 neonates were included. Thirty-five direct comparisons between strategies were made, but no clear evidence of benefit or harm emerged. Certainty of evidence ranged from moderate to very low, often downgraded due to imprecision, risk of bias and inconsistency. The most frequent comparison was DCC versus ICC, with 14 studies (RR 0.90, CI 0.65 to 1.26) for any grade IVH and 11 studies (RR 1.14, CI 0.69 to 1.87) for severe IVH. The second most common comparison, DCC versus I-UCM, showed no benefit: RR 1.03 (CI 0.80 to 1.32; eight studies, 2200 participants) and RR 0.77 (CI 0.35 to 1.66; seven studies, 2032 participants). ICS versus DCC was the only comparison which was rated as moderate certainty of evidence for both, any grade IVH (RR 0.96, CI 0.82 to 1.13) and severe IVH (RR 0.91, CI 0.62 to 1.35). CONCLUSIONS: No umbilical cord management strategy was clearly associated with increased or decreased IVH risk. Evidence certainty was generally low to very low, primarily due to bias and imprecision.
19 Apr 2026
Read appraisal →Archives of gynecology and obstetrics
Comparative validation of a cost-effective in-house 3D-printed LLETZ simulator versus a commercial training model.
PURPOSE: Traditional surgical training methods such as "learning-by-doing" raise ethical and methodological concerns. To improve training and reduce patient risk, a 3D-printed LLETZ simulator was developed. While initial studies showed advantages over a conventional model, they were limited to medical students and lacked comparison with a commercially available simulator. METHODS: A single-center study was conducted at the University Hospital Wuerzburg. 60 medical students without prior LLETZ experience and 10 gynecology residents with prior exposure were randomly assigned to train on either a commercial or the novel in-house simulator. Each participant performed five electrosurgical excisions. Performance was evaluated using LEEP scores, resection status (R0 resections), and blinded video assessments by two senior clinicians. Additionally, participants completed questionnaires, to capture subjective training impressions. RESULTS: The in-house simulator demonstrated superior performance compared to the commercial model. When analyzed separately, changes in LEEP scores over the five attempts were statistically significant for both simulators. The effect size was larger for the in-house simulator (η2 = 0.227) than for the conventional simulator (η2 = 0.10). Within-group analysis revealed no significant pairwise differences across all attempts for the commercial simulator. In contrast, several pairwise comparisons remained statistically significant for the in-house simulator (attempts 1 vs. 3, 1 vs. 4, 2 vs. 5, and 1 vs. 5), all with large effect sizes (Cohen's d > 1.1). Between-group comparison of individual LEEP scores showed a statistically significant difference in the fifth attempt (p = 0.002), with a large effect size (Cohen's d = 1.01) favoring the in-house simulator. Higher R0 resection rates were observed with the in-house simulator in the third (100% vs. 83.3%) and fourth attempts (96.7% vs. 73.3%). Blinded video assessments by two senior experts confirmed these findings, demonstrating higher checklist, Global Rating Scale (GRS), and overall mean scores for the in-house simulator from the third attempt onward (all p < 0.05; all Cohen's d > 0.8). Participant feedback further supported these results, indicating improved confidence, technical skills, and perceived educational value. CONCLUSION: This study demonstrated that the novel in-house 3D-printed simulator significantly outperformed the commercial model in objective surgical performance, learning progression and user satisfaction.
5 Apr 2026
Read appraisal →Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac remodeling in second trimester in pregnancies with pre-eclampsia and/or fetal growth restriction: deep-learning-based approach using population-wide data
OBJECTIVE: Pre-eclampsia (PE) and fetal growth restriction (FGR) have been shown to impact fetal cardiac remodeling in the third trimester and postnatally, with evidence to suggest that this leads to increased long-term cardiovascular risk. This study aimed to examine fetal cardiac remodeling in pregnancies with PE and/or FGR during the second trimester. METHODS: This was a retrospective nationwide cohort study of ultrasound images from routine screening at 18-22 weeks of gestation in Denmark. We included 139 430 singleton pregnancies that were conceived spontaneously for which at least one relevant standardized cardiac plane (four-chamber view and/or three-vessel view) was available from the second-trimester scan. An artificial intelligence model performed automated segmentation and extraction of fetal cardiac biometric measurements. Data were collected for four groups: the reference group, defined as appropriate-for-gestational-age (AGA) fetuses from a normotensive pregnancy (n = 131 150); AGA fetuses from a PE pregnancy (AGA + PE group; n = 3095); FGR fetuses from a normotensive pregnancy (normotensive + FGR group; n = 4572); and FGR fetuses from a PE pregnancy (PE + FGR group; n = 613). Differences between groups in cardiac biometric measurements were presented as Z-scores adjusted for abdominal circumference at the second-trimester scan. RESULTS: Compared with the reference group, fetuses in the PE + AGA group had significantly larger right-sided heart structures, and the main pulmonary artery (MPA) and ventricular septum were wider. Fetuses in the normotensive + FGR group displayed significantly smaller cardiac structures, including smaller MPA and ascending aorta diameters, and increased left ventricular sphericity compared with the reference group. Fetuses in the PE + FGR group differed significantly from the reference group only in terms of smaller left atrial area, narrower ascending aorta and increased left ventricular sphericity. However, PE + FGR fetuses had significantly wider MPA and ventricular septum and larger right-sided structures compared with normotensive + FGR fetuses, mimicking the features of the PE + AGA group, suggesting a distinct effect of PE on fetal cardiac remodeling. CONCLUSIONS: Cardiac remodeling is evident as early as the second trimester, with distinct patterns of modulation in fetuses from pregnancies affected by PE vs FGR. In particular, PE is associated with an enlarged right heart and greater MPA diameter. Understanding these early differences in fetal cardiac morphology may improve risk prediction models and guide early intervention to improve long-term cardiovascular outcome. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
4 Apr 2026
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