A decreased risk of meningioma in women smokers was only observed in American studies rather than studies conducted in other countries: a systematic review and meta-analysis

Abstract Background Whether smoking is related to a decreased risk of meningioma in women is still controversial. We conducted a systematic review and meta-analysis examining the association between smoking and risk of meningiomas in women. Methods Two authors independently performed a systematic literature review in the PubMed, Cochrane Library, and EMBASE databases. We identified case-control and cohort studies quantifying associations between smoking and risk of meningioma in women. A meta-analysis by pooling studies was performed according to the multivariate-adjusted risk estimates and 95% confidence intervals (CIs) preferentially. We further conducted additional subgroup and sensitivity analyses to explore possible explanations of the results. Results A total of seven observational studies were included, with a total of 2132 female patients diagnosed with meningiomas. Ever smoking was associated with a significantly reduced risk of meningioma in women, with pooled odds ratio (OR) of 0.83 (95% CI 0.70–0.98). Similar findings were noted for current (OR 0.78, 95% CI 0.66–0.93) and past (OR 0.82, 95% CI 0.71–0.94) smokers. However, considering the areas, the OR of ever smoking was 0.77 (95% CI 0.68–0.87) in three American studies, but 0.99 (95% CI 0.73–1.35) in four studies conducted in other countries. Conclusions Based on limited epidemiological evidence, a decreased risk of meningioma in women smokers was only observed in American studies rather than studies conducted in other countries.

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Does chronic hyperglycaemia increase the risk of kidney stone disease? results from a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-032094 ◽

2020 ◽

Vol 10 (1) ◽

pp. e032094 ◽

Cited By ~ 2

Author(s):

Robert Geraghty ◽

Abdihakim Abdi ◽

Bhaskar Somani ◽

Paul Cook ◽

Paul Roderick

Keyword(s):

Systematic Review ◽

Kidney Stone ◽

Observational Studies ◽

Meta Analysis ◽

Case Control ◽

Stone Disease ◽

Cochrane Library ◽

Cross Sectional ◽

Kidney Stone Disease ◽

Chronic Hyperglycaemia

DesignSystematic review and meta-analysis of observational studies was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies reporting on diabetes mellitus (DM) or metabolic syndrome (MetS) and kidney stone disease (KSD).ObjectiveTo examine the association between chronic hyperglycaemia, in the form of DM and impaired glucose tolerance (IGT) in the context of MetS and KSD.SettingPopulation-based observational studies. Databases searched: Ovid MEDLINE without revisions (1996 to June 2018), Cochrane Library (2018), CINAHL (1990 to June 2018), ClinicalTrials.gov, Google Scholar and individual journals including the Journal of Urology, European Urology and Kidney International.ParticipantsPatients with and without chronic hyperglycaemic states (DM and MetS).Main outcome measuresEnglish language articles from January 2001 to June 2018 reporting on observational studies. Exclusions: No comparator group or fewer than 100 patients. Unadjusted values were used for meta-analysis, with further meta-regression presented as adjusted values. Bias was assessed using Newcastle-Ottawa scale.Results2340 articles were screened with 13 studies included for meta-analysis, 7 DM (three cohort) and 6 MetS. Five of the MetS studies provided data on IGT alone. These included: DM, n=28 329; MetS, n=31 767; IGT, n=12 770. Controls: DM, n=5 89 791; MetS, n=1 78 050; IGT, n=2 93 852 patients. Adjusted risk for DM cohort studies, RR=1.23 (0.94 to 1.51) (p<0.001). Adjusted ORs for: DM cross-sectional/case-control studies, OR=1.32 (1.21 to 1.43) (p<0.001); IGT, OR=1.26 (0.92 to 1.58) (p<0.0001) and MetS, OR=1.35 (1.16 to 1.54) (p<0.0001). There was no significant difference between IGT and DM (cross-sectional/case-control), nor IGT and MetS. There was a moderate risk of publication bias. Statistical heterogeneity remained significant in adjusted DM cohort values and adjusted IGT (cross-sectional/case-control), but non-signficant for adjusted DM (cross-sectional/case-control).ConclusionChronic hyperglycaemia increases the risk of developing kidney stone disease. In the context of the diabetes pandemic, this will increase the burden of stone related morbidity and mortality.PROSPERO registration numberCRD42018093382

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Diabetes mellitus and the risk of ovarian cancer: a systematic review and meta-analysis of cohort and case–control studies

BMJ Open ◽

10.1136/bmjopen-2020-040137 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040137

Author(s):

Lihai Wang ◽

Lei Zhong ◽

Bin Xu ◽

Min Chen ◽

Hongxiao Huang

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Ovarian Cancer ◽

Cohort Studies ◽

Observational Studies ◽

Meta Analysis ◽

Case Control ◽

Cochrane Library ◽

Case Control Studies ◽

History Of

ObjectiveEmerging evidence from observational studies (cohort and case–control studies) suggests that a history of diabetes mellitus (DM) has been linked to increased risk of ovarian cancer (OC), but the association between them remains inconclusive. The aim of this systematic review and meta-analysis of observational studies was to clarify this association.DesignSystematic review and meta-analysis.MethodsWe searched PubMed, Embase and the Cochrane library databases published from the inception through 9 April 2020 without language restriction. Observational studies that evaluated the correlation between DM and the incidence of OC were included in our study. Relative risk (RR) with 95% CI was pooled by use of a random-effects model.ResultsA total of 36 epidemiological articles, including 9 case–control and 27 cohort studies, were finally enrolled, consisting of 14 496 incident cases of OC. Synthesised RRs of developing OC by history of DM were 1.20 (95% CI=1.10 to 1.31) for all eligible studies, 1.08 (95% CI=0.77 to 1.53) for case–control studies and 1.22 (95% CI=1.11 to 1.33) for cohort studies. The above-mentioned positive association persisted across most of subgroup analyses, whereas it was not significant among studies from North American and European countries, level of unadjusted, and patients with low-quality and gestational DM group. The cumulative meta-analysis and sensitivity analysis showed pooled effect was stable and reliable, and no apparent publication bias was identified in this study.ConclusionsOur study found weaker but still association between DM and OC risk. However, further well-designed prospective studies that control for potential confounders are warranted.

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The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.10683 ◽

2021 ◽

Vol 9 ◽

pp. e10683

Author(s):

Jun Chen ◽

Lingchun Lyu ◽

Jiayi Shen ◽

Chunlai Zeng ◽

Cheng Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Hip Fracture ◽

Fracture Risk ◽

Hip Fractures ◽

Observational Studies ◽

Meta Analysis ◽

Cochrane Library ◽

Hip Fracture Risk ◽

Significant Difference

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

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Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000662 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000662 ◽

Cited By ~ 1

Author(s):

Nick Brown ◽

Antti Juhani Kukka ◽

Andreas Mårtensson

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Low Income ◽

Meta Analysis ◽

Severe Pneumonia ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

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Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies

BMJ Open ◽

10.1136/bmjopen-2018-028238 ◽

2019 ◽

Vol 9 (11) ◽

pp. e028238 ◽

Cited By ~ 7

Author(s):

Shimels Hussien Mohammed ◽

Tesfa Dejenie Habtewold ◽

Mulugeta Molla Birhanu ◽

Tesfamichael Awoke Sissay ◽

Balewgizie Sileshi Tegegne ◽

...

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Observational Studies ◽

Data Extraction ◽

Meta Analysis ◽

Epidemiological Studies ◽

Cochrane Library ◽

Eligibility Criteria ◽

Cross Sectional ◽

Neighbourhood Socioeconomic Status

ObjectiveLow neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual’s own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI).DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019.Eligibility criteriaEpidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included.Data extraction and synthesisData extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran’s Q and I2 statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger’s regression test.ResultA total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m2 increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001).ConclusionNSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity.PROSPERO registration numberCRD42017063889

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Is dezocine effective and safe in preventing opioids-induced cough during general anaesthesia induction? A protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-035691 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035691

Author(s):

Li-xian He ◽

Ken Shao ◽

Jie Ma ◽

Yuan-yuan Zhao ◽

Yun-tai Yao

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

Treatment Effects ◽

Meta Analysis ◽

Biomedical Literature ◽

Sensitivity Analyses ◽

Systemic Review ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Anaesthesia Induction

IntroductionCough is often observed when administrating a bolus of opioids. Opioid-induced cough (OIC) is mostly transient, benign and self-limiting, but could be associated with adverse effects. Numerous pharmacological and non-pharmacological interventions have been used to manage OIC with controversial efficacy and safety. Recent studies suggested that, pretreatment of intravenous dezocine (DZC) could completely suppress OIC during anaesthesia induction. To address this knowledge lack, we will perform a systemic review and meta-analysis to evaluate the efficacy of DZC on OIC and possible complications. We provide here a protocol that will outline the methods and analyses planned for the systematic review.MethodsPubMed, Embase, Cochrane Library, Web of Science as well as Chinese BioMedical Literature & Retrieval System (SinoMed), China National Knowledge Infrastructure, Wanfang Data and VIP Data will be searched from 1978 to 31 December 2019 to identify all randomised controlled trials comparing DZC with placebo on the incidence and severity of OIC. Primary outcomes of interest include the incidence and severity of OIC. Secondary outcomes of interest include possible complications or adverse effects of DZC. Two authors will independently extract relevant variables and outcome data. For continuous variables, treatment effects will be calculated as weighted mean difference and 95% CI. For dichotomous data, treatment effects will be calculated as OR and 95% CI. Each outcome will be tested for heterogeneity, and randomised-effects or fixed-effects model will be used in the presence or absence of significant heterogeneity. Sensitivity analyses will be done by examining the influence of statistical model and individual trial(s) on estimated treatment effects. Publication bias will be explored through visual inspection of funnel plots of the outcomes. Statistical significance will be defined as p<0.05.Ethics and disseminationThis study is a protocol of meta-analysis of previously published literatures, ethical approval was not necessary according to the Ethical Committee of Fuwai Hospital. The study will be submitted to a peer-reviewed journal and disseminated via research presentations.PROSPERO registration numberCRD42019141255.

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Egg Consumption and Risk of Upper Aero-Digestive Tract Cancers: A Systematic Review and Meta-Analysis of Observational Studies

Advances in Nutrition ◽

10.1093/advances/nmz010 ◽

2019 ◽

Vol 10 (4) ◽

pp. 660-672 ◽

Cited By ~ 1

Author(s):

Azadeh Aminianfar ◽

Roohallah Fallah-Moshkani ◽

Asma Salari-Moghaddam ◽

Parvane Saneei ◽

Bagher Larijani ◽

...

Keyword(s):

Systematic Review ◽

Esophageal Cancer ◽

Cohort Studies ◽

Prospective Cohort ◽

Observational Studies ◽

Meta Analysis ◽

Case Control ◽

Egg Consumption ◽

Prospective Cohort Studies ◽

Increased Risk

ABSTRACT Limited data are available that summarize the relation between egg intake and the risk of upper aero-digestive tract (UADT) cancers. This systematic review and meta-analysis was conducted to investigate the association between egg intake and the risk of UADT cancers. Medline/PubMed, ISI web of knowledge, EMBASE, Scopus, and Google Scholar were searched using relevant keywords. Observational studies conducted on humans investigating the association between egg consumption and the risk of UADT cancers were included. Overall, 38 studies with a total of 164,241 subjects (27, 025 cases) were included. Based on 40 effect sizes from 32 case-control studies, we found a 42% increased risk of UADT cancers among those with the highest egg consumption (ranging from ≥1 meal/d to ≥1 time/mo among studies) compared to those with the lowest intake (ranging from 0–20 g/d to never consumed among studies) (overall OR: 1.42; 95% CI: 1.19, 1.68; P < 0.001). However, this association was only evident in hospital-based case-control (HCC) studies (OR = 1.50; 95% CI: 1.34, 1.68; P < 0.001 for ‘oropharyngeal and laryngeal cancer’ and OR: 1.27; 95% CI: 1.08, 1.50; P = 0.004 for esophageal cancer) and not in population-based case-control (PCC) studies (OR = 1.25; 95% CI: 0.59, 2.67; P = 0.56 for ‘oropharyngeal and laryngeal cancer’ and OR: 1.29; 95% CI: 0.92, 1.81; P = 0.13 for esophageal cancer). In addition, the association was not significant in prospective cohort studies (overall OR: 0.86; 95% CI: 0.71, 1.04; P = 0.11). Considering individual cancers, a positive association was observed between the highest egg consumption, compared with the lowest, and risk of oropharyngeal (OR: 1.88; 95% CI: 1.61, 2.20; P < 0.001), laryngeal (OR: 1.83; 95% CI: 1.45, 2.32; P < 0.001), oral & pharyngeal & laryngeal (OR: 1.37; 95% CI: 1.12, 1.67; P < 0.001), and esophageal cancers (OR: 1.28; 95% CI: 1.10,1.48; P = 0.001). We also found an inverse association between egg intake and the risk of oral cancer (OR: 0.78; 95% CI: 0.62, 0.99; P = 0.04). In conclusion, high egg consumption (ranging from ≥1 meal/d to ≥1 time/mo among studies) was associated with increased risk of UADT cancers only in HCC studies but not in PCC or prospective cohort studies. PROSPERO registration number: CRD42018102619.

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Association between green tea intake and risk of gastric cancer: a systematic review and dose–response meta-analysis of observational studies

Public Health Nutrition ◽

10.1017/s1368980017002208 ◽

2017 ◽

Vol 20 (17) ◽

pp. 3183-3192 ◽

Cited By ~ 15

Author(s):

Yanhong Huang ◽

Hongru Chen ◽

Liang Zhou ◽

Gaoming Li ◽

Dali Yi ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

High Temperature ◽

Relative Risk ◽

Green Tea ◽

Dose Response ◽

Observational Studies ◽

Meta Analysis ◽

Case Control ◽

Case Control Studies

AbstractObjectiveTo examine and quantify the potential dose–response relationship between green tea intake and the risk of gastric cancer.DesignWe searched PubMed, EMBASE, Web of Science, CBM, CNKI and VIP up to December 2015 without language restrictions.SettingA systematic review and dose–response meta-analysis of observational studies.SubjectsFive cohort studies and eight case–control studies.ResultsCompared with the lowest level of green tea intake, the pooled relative risk (95 % CI) of gastric cancer was 1·05 (0·90, 1·21, I2=20·3 %) for the cohort studies and the pooled OR (95 % CI) was 0·84 (0·74, 0·95, I2=48·3 %) for the case–control studies. The pooled relative risk of gastric cancer was 0·79 (0·63, 0·97, I2=63·8 %) for intake of 6 cups green tea/d, 0·59 (0·42, 0·82, I2=1·0 %) for 25 years of green tea intake and 7·60 (1·67, 34·60, I2=86·5 %) for drinking very hot green tea.ConclusionsDrinking green tea has a certain preventive effect on reducing the risk of gastric cancer, particularly for long-term and high-dose consumption. Drinking too high-temperature green tea may increase the risk of gastric cancer, but it is still unclear whether high-temperature green tea is a risk factor for gastric cancer. Further studies should be performed to obtain more detailed results, including other gastric cancer risk factors such as smoking and alcohol consumption and the dose of the effective components in green tea, to provide more reliable evidence-based medical references for the relationship between green tea and gastric cancer.

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Can Smartphone Apps Increase Physical Activity? Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.12053 ◽

2018 ◽

Author(s):

Amelia Romeo ◽

Sarah Edney ◽

Ronald Plotnikoff ◽

Rachel Curtis ◽

Jillian Ryan ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Meta Analysis ◽

Target Population ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Smartphone Apps ◽

Intervention Effects ◽

Randomized Controlled ◽

Steps Per Day

BACKGROUND Smartphone apps are a promising tool for delivering accessible and appealing physical activity interventions. Given the large growth of research in this field, there are now enough studies using the “gold standard” of experimental design—the randomized controlled trial design—and employing objective measurements of physical activity, to support a meta-analysis of these scientifically rigorous studies. OBJECTIVE This systematic review and meta-analysis aimed to determine the effectiveness of smartphone apps for increasing objectively measured physical activity in adults. METHODS A total of 7 electronic databases (EMBASE, EmCare, MEDLINE, Scopus, Sport Discus, The Cochrane Library, and Web of Science) were searched from 2007 to January 2018. Following the Population, Intervention, Comparator, Outcome and Study Design format, studies were eligible if they were randomized controlled trials involving adults, used a smartphone app as the primary or sole component of the physical activity intervention, used a no- or minimal-intervention control condition, and measured objective physical activity either in the form of moderate-to-vigorous physical activity minutes or steps. Study quality was assessed using a 25-item tool based on the Consolidated Standards of Reporting Trials checklist. A meta-analysis of study effects was conducted using a random effects model approach. Sensitivity analyses were conducted to examine whether intervention effectiveness differed on the basis of intervention length, target behavior (physical activity alone vs physical activity in combination with other health behaviors), or target population (general adult population vs specific health populations). RESULTS Following removal of duplicates, a total of 6170 studies were identified from the original database searches. Of these, 9 studies, involving a total of 1740 participants, met eligibility criteria. Of these, 6 studies could be included in a meta-analysis of the effects of physical activity apps on steps per day. In comparison with the control conditions, smartphone apps produced a nonsignificant (P=.19) increase in participants’ average steps per day, with a mean difference of 476.75 steps per day (95% CI −229.57 to 1183.07) between groups. Sensitivity analyses suggested that physical activity programs with a duration of less than 3 months were more effective than apps evaluated across more than 3 months (P=.01), and that physical activity apps that targeted physical activity in isolation were more effective than apps that targeted physical activity in combination with diet (P=.04). Physical activity app effectiveness did not appear to differ on the basis of target population. CONCLUSIONS This meta-analysis provides modest evidence supporting the effectiveness of smartphone apps to increase physical activity. To date, apps have been most effective in the short term (eg, up to 3 months). Future research is needed to understand the time course of intervention effects and to investigate strategies to sustain intervention effects over time.

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Global Incidence of Necrotizing Enterocolitis: a Systematic Review and Meta-Analysis

10.21203/rs.3.rs-17868/v2 ◽

2020 ◽

Author(s):

Amer Alsaied ◽

Nazmul Islam ◽

Lukman Thalib

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Publication Bias ◽

Necrotizing Enterocolitis ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Vlbw Infants ◽

Funnel Plots ◽

Substantial Heterogeneity

Abstract Background: Necrotizing Enterocolitis (NEC) is a major cause of morbidity and mortality in the Neonatal Intensive Care Unit (NICU), yet the global incidence of NEC has not been systematically evaluated. We conducted a systematic review and meta-analysis of cohort studies reporting the incidence of NEC in infants with Very Low Birth Weight (VLBW).Methods: The databases searched included PubMed, MEDLINE, the Cochrane Library, EMBASE and grey literature. Eligible studies were cohort or population-based studies of newborns including registry data reporting incidence of NEC. Data were extracted from the selected papers included incidence of NEC cases and size of population at risk, author and publication details, follow up period covered by the study, location and setting of the study and whether it was VLBW infants or preterm infants. Additionally, risk of bias assessment of the included studies were carried out using a validated tool. Bias adjusted Quality Effect Model (QEM) were used to pool the estimates. In the presence of substantial heterogeneity, Random Effect Models (REM) were used as an additionally sensitivity analyses. The heterogeneity between studies were evaluated using the Cochrane Q statistics and Higgin’s I2 value. Subgroup analysis and meta-regression were used to explore the sources of heterogeneity. Funnel plots as appropriate for ratio measures were used to assess publication bias. Results: A systematic and comprehensive search of databases identified 27 cohort studies reporting the incidence of NEC. The pooled estimate of the global incidence of NEC was 6.0% (95% CI: 4.0%-9.0%). There were substantial heterogeneity (I2 = 100%) between studies. Funnel plots showed no evidence of publication bias.Conclusion: Seven out of 100 of all VLBW infants in NICU are likely to develop NEC. However, there were considerable heterogeneity between studies. High quality studies assessing incidence of NEC along with associated risk factors are warranted.

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