The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol

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In the Neonatal Intensive Care Unit (NICU), positioning strategies are commonly employed with the aim of mitigating adverse effects and promoting neurodevelopment in preterm infants. However, the evidence regarding the impact of different positions on neurodevelopmental outcomes remains heterogeneous and inconclusive. Objective The aim of this systematic review is to evaluate the effects of different positioning strategies on neurodevelopmental outcomes in preterm infants admitted to Neonatal Intensive Care Units (NICUs). Methods A comprehensive search will be conducted in electronic databases including PubMed, MEDLINE, EMBASE, and Cochrane Library. To comply with the established guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the systematic review will be conducted to identify relevant studies published up to the date of the search. This systematic review protocol has been registered in PROSPERO to ensure thorough and transparent reporting of the search process, synthesis of findings, and analysis methods. Discussion In the context of preterm infants admitted to Neonatal Intensive Care Units (NICUs), the discussion surrounding the effects of different positions on neurodevelopmental outcomes is multifaceted and warrants careful consideration. Variations in study methodologies, including sample sizes, outcome measures, and follow-up durations, underscore the need for standardized approaches to facilitate comparison and synthesis of findings. The heterogeneity in reported outcomes, ranging from cognitive and motor development to sensory processing, highlights the complexity of neurodevelopmental assessment in this population and emphasizes the importance of comprehensive evaluation frameworks. Through rigorous synthesis and analysis of existing literature, our protocol aims to contribute meaningful insights that can drive future research agendas and enhance neurodevelopmental outcomes for this vulnerable population. Systematic Review Registration number CRD42023492163 " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-314/v1", "name": "The effects of different positions on neurodevelopment in preterm..." } } ] } Home Browse The effects of different positions on neurodevelopment in preterm... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Hullumani S, Raghuveer R and Qureshi MI. The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] . F1000Research 2024, 13 :314 ( https://doi.org/10.12688/f1000research.148711.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] Sharath Hullumani https://orcid.org/0009-0000-2926-5609 1 , Raghumahanti Raghuveer https://orcid.org/0000-0001-7696-0786 2 , Moh'd Irshad Qureshi 2 Sharath Hullumani https://orcid.org/0009-0000-2926-5609 1 , Raghumahanti Raghuveer https://orcid.org/0000-0001-7696-0786 2 , Moh'd Irshad Qureshi 2 PUBLISHED 23 Apr 2024 Author details Author details 1 Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, Maharasthra, 442004, India 2 Department of Neuro Physiotherapy, Datta Meghe Institute Higher Education and Research (DU),, Swangi Meghe, Wardha, Maharasthra, 442204, India Sharath Hullumani Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Raghumahanti Raghuveer Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Resources, Software, Supervision, Writing – Review & Editing Moh'd Irshad Qureshi Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Project Administration, Resources, Software, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Preterm birth poses significant challenges to infant health, with neurodevelopmental outcomes often affected. In the Neonatal Intensive Care Unit (NICU), positioning strategies are commonly employed with the aim of mitigating adverse effects and promoting neurodevelopment in preterm infants. However, the evidence regarding the impact of different positions on neurodevelopmental outcomes remains heterogeneous and inconclusive. Objective The aim of this systematic review is to evaluate the effects of different positioning strategies on neurodevelopmental outcomes in preterm infants admitted to Neonatal Intensive Care Units (NICUs). Methods A comprehensive search will be conducted in electronic databases including PubMed, MEDLINE, EMBASE, and Cochrane Library. To comply with the established guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the systematic review will be conducted to identify relevant studies published up to the date of the search. This systematic review protocol has been registered in PROSPERO to ensure thorough and transparent reporting of the search process, synthesis of findings, and analysis methods. Discussion In the context of preterm infants admitted to Neonatal Intensive Care Units (NICUs), the discussion surrounding the effects of different positions on neurodevelopmental outcomes is multifaceted and warrants careful consideration. Variations in study methodologies, including sample sizes, outcome measures, and follow-up durations, underscore the need for standardized approaches to facilitate comparison and synthesis of findings. The heterogeneity in reported outcomes, ranging from cognitive and motor development to sensory processing, highlights the complexity of neurodevelopmental assessment in this population and emphasizes the importance of comprehensive evaluation frameworks. Through rigorous synthesis and analysis of existing literature, our protocol aims to contribute meaningful insights that can drive future research agendas and enhance neurodevelopmental outcomes for this vulnerable population. Systematic Review Registration number CRD42023492163 READ ALL READ LESS Keywords Infant Positioning, Positions, Preterm Infant, Neonatal intensive Care unit Corresponding Author(s) Sharath Hullumani ( [email protected] ) Close Corresponding author: Sharath Hullumani Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Hullumani S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Hullumani S, Raghuveer R and Qureshi MI. The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] . F1000Research 2024, 13 :314 ( https://doi.org/10.12688/f1000research.148711.1 ) First published: 23 Apr 2024, 13 :314 ( https://doi.org/10.12688/f1000research.148711.1 ) Latest published: 23 Apr 2024, 13 :314 ( https://doi.org/10.12688/f1000research.148711.1 ) Introduction The care and management of preterm infants in Neonatal Intensive Care Units (NICUs) are pivotal for their overall health and developmental outcomes. Among the various factors influencing their development, the positioning of preterm infants has garnered significant attention. Positioning practices in NICUs vary widely, ranging from supine, prone, lateral, and tilted positions, each potentially impacting neurodevelopmental trajectories differently. 1 – 5 Babies born before 37 weeks of gestation are categorized as preterm, disrupting their growth and development within the womb and exposing them to a different environment. Their immature organs aren’t ready for typical newborn care practices like swaddling and breastfeeding. Very preterm (under 28 weeks) and moderately preterm (28–32 weeks) babies often need complex interventions to survive, requiring caregivers with advanced skills. The global impact of prematurity, including its long-term effects, is significant, and more focus is needed on mitigating these negative consequences due to the limited progress in preventing preterm births. Further research is necessary to optimize the growth and development of premature infants, especially regarding neurodevelopmental outcomes. 6 , 7 Although developmental care interventions have shown positive effects on preterm infants’ neurological outcomes and development, consistent implementation of best practices remains lacking. Among these interventions, developmental positioning stands out for its benefits on posture, musculoskeletal health, physiologic outcomes, and sleep patterns. However, there’s no standardized approach to developmental positioning; different methods, including commercial products and simple linen rolls, have been studied. Despite being recognized as crucial in NICUs, developmental positioning is not consistently adopted worldwide, and relying solely on positioning aids can create a false sense of security. Bridging the gap between evidence and practice in NICUs regarding developmental positioning is crucial, as its effectiveness is established, but methods to enhance proficiency in providing such care require further exploration. 8 – 10 The neurodevelopmental journey of preterm infants is particularly sensitive during their NICU stay, given the critical period of brain development occurring outside the womb. The environment provided in the NICU, including the positioning of infants, plays a crucial role in shaping their neurological outcomes. Understanding the effects of different positions on neurodevelopment is paramount for optimizing care protocols and enhancing long-term outcomes for preterm infants. 11 Despite numerous studies examining the influence of positioning on preterm infants’ neurodevelopment, the evidence remains fragmented and lacks comprehensive synthesis. Thus, a systematic review is warranted to consolidate existing literature, elucidate patterns, and provide insights into the optimal positioning strategies for promoting neurodevelopment in preterm infants within NICU settings. 12 – 15 In this systematic review, we aim to analyze and synthesize the available evidence regarding the effects of different positions on neurodevelopmental outcomes in preterm infants admitted to NICUs. By systematically reviewing and critically appraising relevant studies, we seek to identify key factors influencing neurodevelopmental outcomes, explore potential mechanisms underlying the observed effects, and offer recommendations for evidence-based positioning practices in NICU settings. Through this review, we aspire to contribute to the enhancement of NICU care protocols, facilitate informed decision-making among healthcare providers, and ultimately improve the neurodevelopmental outcomes of preterm infants during their critical early stages of life. Review question(s) “Does the available evidence support the influence of different positions on neurodevelopmental outcomes in preterm infants within Neonatal Intensive Care Units. Inclusion criteria Population Preterm infants (gestational age <37 weeks) admitted to Neonatal Intensive Care Units, with inclusion criteria encompassing infants without major congenital anomalies or severe medical complications, and exclusion criteria comprising infants with congenital neurologic disorders or life-threatening conditions. Intervention The interventions involve examining various body positions (e.g., prone, supine, lateral) in preterm infants admitted to Neonatal Intensive Care Units, with inclusion criteria considering studies implementing position-based interventions and exclusion criteria excluding studies with combined interventions or those focusing solely on handling techniques without positional changes. 16 , 17 Comparator The interventions, involving various body positions in preterm infants admitted to Neonatal Intensive Care Units, will be compared against standard care or alternative positioning strategies, with inclusion criteria considering studies with a comparative design, and exclusion criteria involving studies lacking a control group or comparing interventions not related to positional changes. Outcomes The pre-specified main outcomes include neurodevelopmental assessments in preterm infants, defined by standardized tools measuring cognitive, motor, and sensory functions, with inclusion criteria incorporating studies reporting outcomes at follow-up periods during infancy and early childhood. The effect measures for the main outcomes, including cognitive, motor, and sensory functions in preterm infants, will primarily involve standardized mean differences (SMDs) or, if feasible, relative risks (RRs) with 95% confidence intervals, to quantify the impact of different positions on neurodevelopment in Neonatal Intensive Care Units. Type of studies Randomized Controlled trials, Systematic Review will be included. Non-randomized, cross-sectional studies, observational, descriptive studies, observational analytical research designs, such as case-control & and cohort studies, and qualitative study designs, such as qualitative case studies, narrative studies, etc., will be excluded. Since there are no resources available for translating research written in languages other than English, only published and unpublished English-language studies will be included. Targeted research that has been published between 2004-2024 will be included. Methods This protocol describes how a systematic review should be carried out in compliance with the PRISMA-P recommendations for systematic reviews that have been referred to. The F1000 journal methodology for the systematic review of effectiveness will be followed in all steps involved in carrying out this systematic review. This systematic review protocol has been registered in PROSPERO (CRD42023492163). Search strategy Selection Criteria: Studies that meet the inclusion requirements positioning techniques will be chosen. A thorough exploration of several electronic databases, such as PubMed/Medline, Scopus, and Cochrane Library, will be carried out to locate pertinent research articles published in peer-reviewed publications. Study selection The research findings will be managed using citation management software. After removing duplicates, two reviewers from each team will utilize Rayyan QCRI to screen and assess titles and abstracts in three domains based on inclusion and exclusion criteria. 18 , 19 Using RRID, three independent reviewers will further scrutinize titles and abstracts against the review’s criteria. Once the initial screening is complete, all pertinent studies will undergo comprehensive evaluation by three independent reviewers to determine adherence to inclusion criteria. The final analysis will document reasons for exclusion of full-text papers that did not meet the inclusion criteria. Assessment of methodological quality and risk of bias Studies will be selected based on predefined inclusion/exclusion criteria, and data extraction will involve relevant details such as study design, participant characteristics, interventions, outcomes, and follow-up periods, using a standardized form, with extraction and recording conducted independently by two reviewers and discrepancies resolved through consensus. In addition, a concurrent risk of bias assessment will be performed on the publications using the Standards for Reporting Implementation Studies (StaRI) 20 checklist and, PEDRO Scale for rating the methodological quality of RCTs selected. 21 , 22 It is also determined in advance to use the SWiM (Synthesis without Meta-analysis) 20 guidelines to create a narrative overview of the chosen papers from the standpoint of implementation research. Data extraction Data items: Studies will be selected based on predefined criteria; data extraction will include study design, participant characteristics, interventions, and outcomes, performed using a standardized form; two independent reviewers will conduct the process, with discrepancies resolved through consensus and recorded systematically. Extraction method: To methodically record pertinent data from each included study, a uniform data extraction form will be designed in Microsoft Excel sheet. The data will be extracted by two impartial reviewers, and any disagreements will be settled by discussion or, if required, consultation with a third reviewer. Data synthesis The effect measures for the main outcomes, including cognitive, motor, and sensory functions in preterm infants, will primarily involve standardized mean differences (SMDs) or, if feasible, relative risks (RRs) with 95% confidence intervals, to quantify the impact of different positions on neurodevelopment in Neonatal Intensive Care Units. A detailed summary of the primary findings drawn from the included studies will be given, detailing the features of the subjects, the interventions, and the results. The narrative synthesis will entail a qualitative examination of the parallels and discrepancies among the study findings, with an emphasis on how well positing techniques impact the neurodevelopment in preterm infants. Study status Piloting of the study selection process is being undertaken. Discussion The findings of this systematic review provide insights into the complex interplay between positioning and neurodevelopment in preterm infants admitted to NICUs. While prone positioning may offer benefits for motor development, concerns regarding safety and adverse respiratory outcomes limit its widespread adoption. Conversely, supine positioning, while protective against SIDS, raises concerns regarding its potential impact on motor development. Lateral positioning and semi-reclined positioning represent alternative strategies that warrant further investigation to optimize neurodevelopmental outcomes in preterm infants. 23 , 24 Clinical practice should prioritize individualized positioning strategies tailored to the specific needs of preterm infants, taking into account their gestational age, medical condition, and developmental stage. Multidisciplinary collaboration between neonatologists, physical therapists, and developmental specialists is essential to optimize positioning practices and minimize adverse outcomes. Future research should focus on longitudinal studies evaluating the long-term effects of different positioning strategies on neurodevelopmental outcomes, including motor, cognitive, and sensory function. In conclusion, positioning plays a crucial role in the care of preterm infants admitted to NICUs, with potential implications for neurodevelopmental outcomes. Clinicians should weigh the benefits and risks of different positions and prioritize evidence-based practices to promote optimal neurodevelopment in this vulnerable population. Further research is needed to elucidate the optimal positioning strategies that balance the competing priorities of safety, respiratory support, and neurodevelopmental optimization in preterm infants. Ethical considerations Not applicable. Data availability statement No data are associated with this article. Extended data Figshare: PRISMA-P-checklist (A Systematic Review on the effects of Different Positions on Neurodevelopment in Preterm Infants admitted in Neonatal Intensive Care Units).pdf. https://doi.org/10.6084/m9.figshare.25283671.v1 . Figshare: Preliminary Data Search Strategy for A Systematic Review on the effects of Different Positions on Neurodevelopment in Preterm Infants admitted in Neonatal Intensive Care Units. https://figshare.com/s/a7b9cd9afe297050cf91 . Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Flacking R, Lehtonen L, Thomson G, et al. : Closeness and separation in neonatal intensive care. Acta Paediatr. 2012 Oct; 101 (10): 1032–1037. PubMed Abstract | Publisher Full Text | Free Full Text 2. Wang Y, Zhao T, Zhang Y, et al. : Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed. Med. 2021 Apr; 16 (4): 282–291. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Apr 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, Maharasthra, 442004, India 2 Department of Neuro Physiotherapy, Datta Meghe Institute Higher Education and Research (DU),, Swangi Meghe, Wardha, Maharasthra, 442204, India Sharath Hullumani Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Raghumahanti Raghuveer Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Resources, Software, Supervision, Writing – Review & Editing Moh'd Irshad Qureshi Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Project Administration, Resources, Software, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 23 Apr 2024, 13:314 https://doi.org/10.12688/f1000research.148711.1 Copyright © 2024 Hullumani S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Hullumani S, Raghuveer R and Qureshi MI. The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] . F1000Research 2024, 13 :314 ( https://doi.org/10.12688/f1000research.148711.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 23 Apr 2024 Views 0 Cite How to cite this report: Baraldi E and Cavicchiolo ME. Reviewer Report For: The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] . F1000Research 2024, 13 :314 ( https://doi.org/10.5256/f1000research.163058.r405122 ) The direct URL for this report is: https://f1000research.com/articles/13-314/v1#referee-response-405122 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Aug 2025 Eugenio Baraldi , University of Padua, Padua, Italy Maria Elena Cavicchiolo , Department of Woman's and Child's Helath, University of Padua Department of Women's and Children's Health (Ringgold ID: 165488), Padua, Veneto, Italy Approved VIEWS 0 https://doi.org/10.5256/f1000research.163058.r405122 This is a well written protocol, the introduction outlines the clinical problem: preterm infants face neurodevelopmental challenges, and positioning in the NICU may influence outcomes. The knowledge gap is well-defined: existing studies are heterogeneous and inconclusive and the objective is ... Continue reading READ ALL This is a well written protocol, the introduction outlines the clinical problem: preterm infants face neurodevelopmental challenges, and positioning in the NICU may influence outcomes. The knowledge gap is well-defined: existing studies are heterogeneous and inconclusive and the objective is explicit: to evaluate the effects of different positioning strategies on neurodevelopmental outcomes in preterm infants in NICUs. The study design seems appropriate: a systematic review is the most suitable approach. I see some limitations in the study design: methods for handling missing or incomplete data are not described and no detailed plan for addressing heterogeneity (other than narrative synthesis) is provided. Overall this protocol is well-prepared, addresses a relevant clinical question, and sets a solid foundation for a systematic review that could meaningfully inform NICU practices. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Neonatology, follow up, neurodevelopmental outcomes We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Baraldi E and Cavicchiolo ME. Reviewer Report For: The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] . F1000Research 2024, 13 :314 ( https://doi.org/10.5256/f1000research.163058.r405122 ) The direct URL for this report is: https://f1000research.com/articles/13-314/v1#referee-response-405122 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Sep 2025 Dr. Sharath Hullumani V , Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, 442004, India 10 Sep 2025 Author Response Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your ... Continue reading Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your acknowledgment of the clinical relevance of our objective. Your comments regarding the limitations are very helpful. We agree that clarifying our approach to handling missing or incomplete data, as well as providing a more detailed plan for addressing potential heterogeneity, will strengthen the protocol. We will incorporate specific strategies such as sensitivity analyses, subgroup analyses, and, where appropriate, meta-regression to address heterogeneity systematically. Additionally, we will explicitly outline our procedures for dealing with incomplete data to ensure methodological rigor. We are grateful for your insightful review, which will help us refine the protocol further and enhance its quality. Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your acknowledgment of the clinical relevance of our objective. Your comments regarding the limitations are very helpful. We agree that clarifying our approach to handling missing or incomplete data, as well as providing a more detailed plan for addressing potential heterogeneity, will strengthen the protocol. We will incorporate specific strategies such as sensitivity analyses, subgroup analyses, and, where appropriate, meta-regression to address heterogeneity systematically. Additionally, we will explicitly outline our procedures for dealing with incomplete data to ensure methodological rigor. We are grateful for your insightful review, which will help us refine the protocol further and enhance its quality. Competing Interests: None. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Sep 2025 Dr. Sharath Hullumani V , Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, 442004, India 10 Sep 2025 Author Response Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your ... Continue reading Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your acknowledgment of the clinical relevance of our objective. Your comments regarding the limitations are very helpful. We agree that clarifying our approach to handling missing or incomplete data, as well as providing a more detailed plan for addressing potential heterogeneity, will strengthen the protocol. We will incorporate specific strategies such as sensitivity analyses, subgroup analyses, and, where appropriate, meta-regression to address heterogeneity systematically. Additionally, we will explicitly outline our procedures for dealing with incomplete data to ensure methodological rigor. We are grateful for your insightful review, which will help us refine the protocol further and enhance its quality. Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your acknowledgment of the clinical relevance of our objective. Your comments regarding the limitations are very helpful. We agree that clarifying our approach to handling missing or incomplete data, as well as providing a more detailed plan for addressing potential heterogeneity, will strengthen the protocol. We will incorporate specific strategies such as sensitivity analyses, subgroup analyses, and, where appropriate, meta-regression to address heterogeneity systematically. Additionally, we will explicitly outline our procedures for dealing with incomplete data to ensure methodological rigor. We are grateful for your insightful review, which will help us refine the protocol further and enhance its quality. Competing Interests: None. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Apr 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 23 Apr 24 read Eugenio Baraldi , University of Padua, Padua, Italy Maria Elena Cavicchiolo , University of Padua Department of Women's and Children's Health (Ringgold ID: 165488), Padua, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Baraldi E et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Aug 2025 | for Version 1 Eugenio Baraldi , University of Padua, Padua, Italy Maria Elena Cavicchiolo , Department of Woman's and Child's Helath, University of Padua Department of Women's and Children's Health (Ringgold ID: 165488), Padua, Veneto, Italy 0 Views copyright © 2025 Baraldi E et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a well written protocol, the introduction outlines the clinical problem: preterm infants face neurodevelopmental challenges, and positioning in the NICU may influence outcomes. The knowledge gap is well-defined: existing studies are heterogeneous and inconclusive and the objective is explicit: to evaluate the effects of different positioning strategies on neurodevelopmental outcomes in preterm infants in NICUs. The study design seems appropriate: a systematic review is the most suitable approach. I see some limitations in the study design: methods for handling missing or incomplete data are not described and no detailed plan for addressing heterogeneity (other than narrative synthesis) is provided. Overall this protocol is well-prepared, addresses a relevant clinical question, and sets a solid foundation for a systematic review that could meaningfully inform NICU practices. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Neonatology, follow up, neurodevelopmental outcomes We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 10 Sep 2025 Dr. Sharath Hullumani V, Department of Paediatrics Physiotherapy, Datta Meghe Institute Higher Education and Research (DU), Sawangi Meghe, Wardha, 442004, India Thank you very much for your thoughtful and constructive feedback on our protocol. We appreciate your recognition of the strengths in the introduction and study design, as well as your acknowledgment of the clinical relevance of our objective. Your comments regarding the limitations are very helpful. We agree that clarifying our approach to handling missing or incomplete data, as well as providing a more detailed plan for addressing potential heterogeneity, will strengthen the protocol. We will incorporate specific strategies such as sensitivity analyses, subgroup analyses, and, where appropriate, meta-regression to address heterogeneity systematically. Additionally, we will explicitly outline our procedures for dealing with incomplete data to ensure methodological rigor. We are grateful for your insightful review, which will help us refine the protocol further and enhance its quality. View more View less Competing Interests None. reply Respond Report a concern Baraldi E and Cavicchiolo ME. Peer Review Report For: The effects of different positions on neurodevelopment in preterm infants admitted in neonatal intensive care units: a systematic review protocol [version 1; peer review: 1 approved] . F1000Research 2024, 13 :314 ( https://doi.org/10.5256/f1000research.163058.r405122) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-314/v1#referee-response-405122 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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