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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Systematic Reviews 1/2017

A systematic review of neonatal treatment intensity scores and their potential application in low-resource setting hospitals for predicting mortality, morbidity and estimating resource use

Systematic Reviews > Ausgabe 1/2017
Jalemba Aluvaala, Gary S. Collins, Michuki Maina, James A. Berkley, Mike English
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13643-017-0649-6) contains supplementary material, which is available to authorized users.



Treatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings.


We conducted a systematic search of PubMed, EMBASE (OVID), CINAHL, Global Health Library (Global index, WHO) and Google Scholar to identify studies published up until 21 December 2016. Included were all articles that used treatments as predictors in neonatal models. Individual studies were appraised using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). In addition, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used as a guiding framework to assess certainty in the evidence for predicting outcomes across studies.


Three thousand two hundred forty-nine articles were screened, of which ten articles were included in the review. All of the studies were conducted in neonatal intensive care units with sample sizes ranging from 22 to 9978, with a median of 163. Two articles reported model development, while eight reported external application of existing models to new populations. Meta-analysis was not possible due heterogeneity in the conduct and reporting of the identified studies. Discrimination as assessed by area under receiver operating characteristic curve was reported for in-hospital mortality, median 0.84 (range 0.75–0.96, three studies), early adverse outcome and late adverse outcome (0.78 and 0.59, respectively, one study).


Existing neonatal treatment intensity models show promise in predicting mortality and morbidity. There is however low certainty in the evidence on their performance in essential neonatal care in low resource settings as all studies had methodological limitations and were conducted in intensive care. The approach may however be developed further for low resource settings like Kenya because treatment data may be easier to obtain compared to measures of physiological status.

Systematic review registration

PROSPERO CRD42016034205
Additional file 1: Summary of prognostic models for predicting in-hospital neonatal mortality. Comparison of predictors and outcomes of neonatal prognostic models included in published reviews. (DOCX 15 kb)
Additional file 2: PRISMA checklist. Completed PRISMA checklist. (DOC 63 kb)
Additional file 3: Application of GRADE as a guide in assessing certainty of evidence in prediction modelling studies. GRADE* criteria that were used as a guiding framework in assessing the certainty in the evidence for outcomes across the identified studies. *Grading of Recommendations Assessment, Development and Evaluation. (DOCX 14 kb)
Additional file 4: Using GRADE* as a guiding framework in rating of certainty of evidence in predictive model predictive performance. Description of the four categories in GRADE for rating certainty of evidence. *Grading of Recommendations Assessment, Development and Evaluation. (DOCX 13 kb)
Additional file 5: Summary of results from individual studies. Summary of data extracted from each eligible article. (DOCX 17 kb)
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