Cochrane’s systematic reviews are playing a key role in informing the World Health Organization’s (WHO) guidelines for managing preterm infants, including respiratory interventions. These reviews, led by Cochrane Sweden and Cochrane Neonatal, are providing the evidence that is directly shaping recommendations on treatments like caffeine therapy to support lung function in preterm babies.
Preterm birth remains one of the leading causes of infant mortality worldwide. In response, the WHO regularly updates its guidelines to enhance care and improve outcomes for these vulnerable infants. By basing its recommendations on the latest and most reliable data from Cochrane reviews, the WHO ensures that its guidance remains both relevant and evidence based.
“Our guideline development process is very rigorous and evidence-based,” says Marge Reinap Technical Officer, Evidence-based Policy at the WHO. “All our questions and recommendations rely on evidence synthesis. Without evidence synthesis, the guideline development panel cannot issue a recommendation. The evidence synthesis developed by Cochrane is instrumental and serves as the pillar point of WHO’s normative guidance, facilitating discussions and forming recommendations.”
The collaboration began when the WHO commissioned Cochrane Sweden and Cochrane Neonatal to conduct systematic reviews on interventions for preterm infants. These reviews, led by Matteo Bruschettini, Director of Cochrane Sweden, explored the evidence around caffeine to improve health outcomes for preterm infants. Studies have shown that caffeine therapy improves lung function and reduces both mortality and long-term disabilities in preterm infants.
The impact of these Cochrane reviews on WHO guidelines was immediate. The evidence gathered was directly incorporated into the WHO’s updated recommendations on the care of preterm infants, giving healthcare providers around the world clear, evidence-based guidance to improve the survival and health outcomes of these infants.
Beyond influencing global policy, Cochrane Sweden is now working on adapting the WHO guidelines for the Swedish healthcare system. This framework, known as ‘GRADE ADOLOPMENT’, involves modifying guidelines made by others to fit specific national contexts. GRADE refers to the ‘Grading of Recommendations, Assessment, Development and Evaluation’ approach, while ‘ADOLOPMENT’ means adopting, adapting, and/or developing new recommendations.
“Combining the strengths of the Cochrane network, evidence and methodologies with the GRADE ADOLOPMENT framework is very helpful for making recommendations applicable to the Swedish setting,” says Matteo Bruschettini. “It’s an efficient way to make tailored recommendations based on solid foundations, without duplicating efforts.”
Cochrane Sweden, in collaboration with the WHO and members from the GRADE Working Group are working towards that the adapted guideline are tailored to the Swedish needs and healthcare environment while maintaining the same high standard of evidence-based recommendations.
While WHO’s guidelines provide a comprehensive framework, countries often need to adjust them to align with their healthcare systems. In Sweden, Cochrane’s work focuses on ensuring that the guidelines not only address local concerns but also meet the practical needs of healthcare providers. This demonstrates how robust global evidence can be translated into actionable, country-specific recommendations.
“We’re in the process of making guidelines made by others more used in the Swedish setting,” says Martin Ringsten, Project Coordinator at Cochrane Sweden. “It would save a lot of time and resources to use the evidence included in guidelines made by others. Guideline developers can then adopt or adapt recommendations and add contextual evidence where it’s needed.”
Cochrane Sweden’s involvement in the development and adaptation of these guidelines and included systematic reviews highlights how systematic reviews inform clinical guidelines and public health policy. This collaboration ensures that healthcare recommendations are based on the best available evidence and contextualized to the applicable settings, thereby enhancing the quality and relevance of healthcare practices at both global and national levels.
The process of using and contextualizing guidelines for specific settings illustrates how Cochrane reviews integrated into these guidelines can directly impact healthcare practice and policy, both globally and nationally.