The future of Cochrane Neonatal

Area of Science:

• Neonatal medicine and evidence-based healthcare.
• Systematic review methodology and research synthesis.
• Clinical trial design and implementation in neonatology.

Background:

• Cochrane Neonatal, originating from the Oxford Database of Perinatal Trials, has a long history of synthesizing research for perinatal and neonatal care.
• The group has produced numerous systematic reviews influencing international guidelines and research, but faces challenges with declining randomized controlled trials (RCTs) in neonatology.
• Shifting priorities in academic medicine and the complexity of modern interventions contribute to a decrease in published neonatal RCTs.

Purpose of the Study:

• To review the historical contributions and assess the future role of Cochrane Neonatal in advancing evidence-based neonatal care.
• To identify challenges in current neonatal research, including declining RCTs and the need for innovative methodologies.
• To propose strategies for future neonatal research, emphasizing adaptive and cluster trial designs, standardized outcomes, and improved synthesis methods.

Main Methods:

• Analysis of the historical development and impact of Cochrane Neonatal's systematic reviews.
• Examination of trends in published neonatal randomized controlled trials.
• Discussion of innovative research designs (adaptive, cluster, pragmatic trials) and methodological advancements (network meta-analysis, individual patient data meta-analysis, core outcome sets).

Main Results:

• Cochrane Neonatal reviews have significantly informed global guidelines and spurred important research initiatives.
• There has been a notable decline in the number of published neonatal randomized controlled trials since 2015.
• Innovative trial designs, standardized core outcome measures, and improved synthesis techniques are crucial for future research.

Conclusions:

• Cochrane Neonatal must adapt by leading with innovative synthesis approaches and collaborating closely with guideline developers.
• Addressing the decline in neonatal research requires embracing novel trial designs, standardizing outcome measures, and enhancing research efficiency.
• Future efforts should focus on user needs, improving the interpretation of evidence, and fostering a research-friendly culture within the neonatal community.