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The role and limitations of Cochrane reviews at the bedside: a systematic synopsis of five pediatric subspecialties



Cochrane meta-analyses provide the physician at the bedside with the most relevant, up-to-date clinical information. However, implementation of evidence-based medicine (EBM) at the bedside may be difficult for a variety of reasons. The aim of this study was to assess relevant issues and obstacles related to implementing EBM in pediatrics in real life at the bedside/cotside.


We performed five systematic literature reviews of all published Cochrane reviews in neonatology (1996–2010), pediatric neurology (1996–2010), pediatric gastroenterology (1993–2012), pediatric cardiology (2001–2015), and complementary and alternative medicine (1996–2012; CAM) in children and neonates. In all five analyses, the main outcome variables were percentage of reviews concluding that a certain intervention provides a benefit, percentage of reviews concluding that a certain intervention should not be performed, and percentage of studies concluding that the current level of evidence is inconclusive.


In all five areas of pediatrics, a substantial number of Cochrane reviews yielded inconclusive data (neonatology: 46.6%; neuropediatrics: 26.8%; pediatric gastroenterology: 27.9%; pediatric cardiology: 42.9%; complementary and alternative medicine: 66.9%).


Our up-dated systematic synopsis reiterates the need for high-quality, sophisticated research to reduce the number of inconclusive meta-analyses in the field of pediatrics—most importantly in the field of complementary and alternative medicine (CAM), neonatology, and pediatric cardiology. The realization of high-quality, clinically driven research will in turn yield more systematic reviews with a clear conclusion (e. g., in favor or against a certain intervention, or treatment modality), thus, substantively decreasing the proportion of inconclusive reviews.

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Complementary and alternative medicine


Evidence-based medicine


Extremely low birth weight


Randomized controlled trial


Very low birth weight


  1. US PreventiveServices Task Force, Melnyk BM, Grossman DC, Chou R, et al. USPSTF perspective on evidence-based preventive recommendations for children. Pediatrics. 2012;130:e399–407.

    Article  Google Scholar 

  2. Dawes M. Putting evidence into practice. BMJ. 2011;342:d2072. doi:10.1136/bmj.d2072.

    Article  PubMed  Google Scholar 

  3. Lundh A, Sismondo S, Lexchin J, Busuioc OA, Bero L. Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2012; . doi:10.1002/14651858.mr000033.pub2.

    PubMed  Google Scholar 

  4. Meyer S, Schroeder N, Willhelm C, Gortner L, Girisch W. Clinical recommendations of Cochrane reviews in three different fields of pediatrics (neonatology, neuropediatrics, and complementary and alternative medicine): a systematic analysis. Pediatr Int. 2013;55:396–8.

    Article  PubMed  Google Scholar 

  5. Willhelm C, Girisch W, Gortner L, Meyer S. Evidence-based medicine and Cochrane reviews in neonatology: quo vadis? Acta Paediatr. 2012;101:352–3.

    Article  PubMed  Google Scholar 

  6. Girisch W, Willhelm C, Gottschling S, Gortner L, Meyer S. Role of Cochrane reviews in pediatric neurology. Pediatr Neurol. 2012;46:63–9.

    Article  PubMed  Google Scholar 

  7. Goda Y, Sauer H, Schöndorf D, Hennes P, Gortner L, Gräber S, Meyer S. Clinical recommendations of Cochrane reviews in pediatric gastroenterology: systematic analysis. Pediatr Int. 2015;57:98–106.

    Article  PubMed  Google Scholar 

  8. Meyer S, Gortner L, Larsen A, Kutschke G, Gottschling S, Gräber S, Schroeder N. Complementary and alternative medicine in paediatrics: a systematic overview/synthesis of Cochrane Collaboration reviews. Swiss Med Wkly. 2013;143:w13794. doi:10.4414/smw.2013.13794.

    PubMed  Google Scholar 

  9. Alderson P, Chalmers I. Survey of claims of no effect in abstracts of Cochrane reviews. BMJ. 2003;326:475.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Meyer S, Gottschling S, Gortner L. Evidence-based medicine in neonatology: time to re-think. Eur J Pediatr. 2008;167:1089.

    Article  PubMed  Google Scholar 

  11. Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr. 2012;101:1232–9.

    Article  PubMed  Google Scholar 

  12. Thome UH, Genzel-Boroviczeny O, Bohnhorst B, Schmid M, Fuchs H, Rohde O, Avenarius S, Topf HG, Zimmermann A, Faas D, Timme K, Kleinlein B, Buxmann H, Schenk W, Segerer H, Teig N, Gebauer C, Hentschel R, Heckmann M, Schlösser R, Peters J, Rossi R, Rascher W, Böttger R, Seidenberg J, Hansen G, Zernickel M, Alzen G, Dreyhaupt J, Muche R, Hummler HD, PHELBI Study Group. Permissive hypercapnia in extremely low birthweight infants (PHELBI): a randomised controlled multicentre trial. Lancet Respir Med. 2015;3:534–43.

    Article  PubMed  Google Scholar 

  13. Levesque BM, Kalish LA, LaPierre J, Welch M, Porter V. Impact of implementing 5 potentially better respiratory practices on neonatal outcomes and costs. Pediatrics. 2011;128(1):e218–26.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wiles JR, Vinks AA, Akinbi H. Federal legislation and the advancement of neonatal drug studies. J Pediatr. 2013;162:12–5.

    Article  PubMed  Google Scholar 

  15. Chaudhari T, McGuire W. Allopurinol for preventing mortality and morbidity in newborn infants with hypoxic-ischaemic encephalopathy. Cochrane Database Syst Rev. 2012; . doi:10.1002/14651858.CD006817.pub3.

    PubMed  Google Scholar 

  16. Fergusson DA, Hébert P, Hogan DL, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birthweight infants: the ARIPI randomized trial. JAMA. 2012;308:1443–51.

    CAS  Article  PubMed  Google Scholar 

  17. Brown JV, Moe-Byrne T, Harden M, McGuire W. Lower versus higher oxygen concentration for delivery room stabilisation of preterm neonates: systematic review. PLOS ONE. 2012;7(12):e52033.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Sascha Meyer.

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S. Meyer, M. Poryo, S. Khosrawikatoli, Y. Goda, and M. Zemlin declare that they have no competing interests.

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Contributors S. Meyer was responsible for study design, data analysis and synthesis, and writing of the manuscript; M. Poryo was responsible for data analysis and synthesis, and critical revision of the manuscript; S. Khosrawikatoli was involved in data compilation and analysis; Y. Goda was involved in data compilation and analysis; M. Zemlin was responsible for data analysis and critical review of the manuscript; S. Meyer and M. Poryo contributed equally to this work.

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Meyer, S., Poryo, M., Khosrawikatoli, S. et al. The role and limitations of Cochrane reviews at the bedside: a systematic synopsis of five pediatric subspecialties. Wien Med Wochenschr 167, 276–281 (2017).

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  • Complementary and alternative medicine
  • Evidence-based medicine
  • Neonatology
  • Neuropediatrics
  • Pediatric gastroenterology
  • Pediatric cardiology