Sequential analysis in neonatal research—systematic review
As more new drugs are discovered, traditional designs come at their limits. Ten years after the adoption of the European Paediatric Regulation, we performed a systematic review on the US National Library of Medicine and Excerpta Medica database of sequential trials involving newborns. Out of 326 identified scientific reports, 21 trials were included. They enrolled 2832 patients, of whom 2099 were analyzed: the median number of neonates included per trial was 48 (IQR 22–87), median gestational age was 28.7 (IQR 27.9–30.9) weeks. Eighteen trials used sequential techniques to determine sample size, while 3 used continual reassessment methods for dose-finding. In 16 studies reporting sufficient data, the sequential design allowed to non-significantly reduce the number of enrolled neonates by a median of 24 (31%) patients (IQR − 4.75 to 136.5, p = 0.0674) with respect to a traditional trial. When the number of neonates finally included in the analysis was considered, the difference became significant: 35 (57%) patients (IQR 10 to 136.5, p = 0.0033).
What is known:
• In evaluating rare diseases in fragile populations, traditional designs come at their limits. About 20% of pediatric trials are discontinued, mainly because of recruitment problems.
What is new:
• Sequential trials involving newborns were infrequently used and only a few (n = 21) are available for analysis.
• The sequential design allowed to non-significantly reduce the number of enrolled neonates by a median of 24 (31%) patients (IQR − 4.75 to 136.5, p = 0.0674).
KeywordsSequential analysis Clinical trial Neonatology Methodology Systematic review
Consolidated Standards of Reporting Trials
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Sebastiano A.G. Lava
Authors would like to thank Dr. Alec Villa for his assistance in linguistic revision.
Study idea, study design: Dr. Lava, Prof. Jacqz-Aigrain
Article screening, article selection, data extraction: Dr. Lava, Dr. Elie
Statistical analysis: Dr. Lava, Ms. Ha
First draft of the manuscript: Dr. Lava
Figures: Dr. Lava
Critical revision of the manuscript: Prof. Jacqz-Aigrain, Dr. Lava
Approval of the final manuscript: Dr. Lava, Dr. Elie, Dr. Ha, Prof. Jacqz-Aigrain
Dr. Lava is the current recipient of research grants from the Fondazione Ettore e Valeria Rossi, the Batzebär foundation and the Swiss National Science Foundation.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflicts of interest.
This study is a systematic review of the literature. Therefore, it involves neither direct patient contact nor animal exposure. This article does not contain any studies with human participants or animals performed by any of the authors.
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