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Corticosteroids for the prevention of bronchopulmonary dysplasia in preterm infants: a network meta-analysis
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  • Published on:
    Methodology concerns about a network meta-analysis
    • Yan-Jin Liu, Dr The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
    • Other Contributors:
      • Bing-Kun Zheng, Neonatology Fellow

    Dear Editor,
    We read with great interest the network meta-analysis performed by Zeng et al [1]. The authors investigated the comparative efficacy and safety of different corticosteroids in the prevention of bronchopulmonary dysplasia in preterm infants. They included 47 RCTs with 6747 participants. We have several concerns about the study.
    First, it looks that the authors are unfamiliar with the procedures of network meta-analysis because there were obvious mistakes. Figure 1 in the study was network plot of different corticosteroids. In Figure 1, the circle size should be proportional to the sample size randomised to each intervention [2]. The line width should be proportional to the study numbers of each direct comparison. However, the circle size was not proportional to the sample size in Figure 1. The line width between dexamethasone (high dose) and placebo also seems inadequate.
    Second, various statistical methods or plots have been suggested to assist interpreting the results of network meta-analysis [3]. However, many of them were not performed or presented in this study. For example, since there were direct estimates (i.e., results of pairwise meta-analysis) and indirect estimates (i.e., results of network meta-analysis), the inconsistency between them should be assessed and explored because important inconsistency could threaten the validity of the results. Besides, the authors also didn’t assess small-study effects. Small-study effects could mat...

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    Conflict of Interest:
    None declared.