Follow‐Up After Preterm Birth: Where Evidence Ends and Uncertainty Begins

Ilari Kuitunen How much do we currently know about the optimal follow-up for preterm neonates and is there evidence to guide the practice? In the study by Kaiser and colleagues published in Acta Paediatrica, the authors examine this question by systematically mapping the available evidence 7. Their work was undertaken as part of the development of an updated German guideline on post-discharge follow-up care for children born preterm. The authors evaluated the landscape of systematic reviews that could inform guideline development, an approach that provides an overview of the strength and distribution of existing evidence. After screening literature, the authors found 239 systematic reviews meeting the inclusion criteria. The aim was to focus solely on the quality reviews to reduce the burden of the guideline taskforce. Thus, the methodological quality was assessed, and only a small fraction of these reviews proved suitable for informing clinical recommendations. Among the 42 systematic reviews examining interventions, only seven were rated as having moderate or high methodological quality. The remaining reviews were downgraded because of common methodological weaknesses, such as the absence of prospective protocols, lack of duplicate screening or incomplete reporting of excluded studies. Even more striking was the situation for reviews addressing prognosis, risk or prevalence. Of 183 reviews in this category, only five met the criteria for further methodological assessment, and only two were ultimately judged to be of high quality according to A MeaSurement Tool to Assess Systematic Reviews 8. No diagnostic or qualitative reviews fulfilled the methodological standards required for guideline development. These findings highlight a growing concern within evidence-based medicine and also in neonatology: the rapid expansion of systematic reviews does not necessarily translate into reliable evidence as even meta-analyses published in high impact journals may have notable methodological limitations 9. Overall, the issue also highlights the current view of neonatology, where better quality evidence for many interventions is still needed 10, 11. At the same time, the mapping review provides important insights into the thematic focus of existing research 7. Most interventional systematic reviews concentrate on nutritional strategies, supplementation or medication. Non-pharmacological interventions were largely centred on early developmental support and structured follow-up programmes. These areas reflect the traditional focus of neonatal follow-up research, which has understandably prioritized early developmental outcomes. However, the study also reveals notable gaps in the evidence base. Psychosocial factors and family-related influences were under-represented in the literature. This imbalance matters because the long-term consequences of preterm birth extend beyond early childhood development. As increasing numbers of preterm infants survive into adolescence and adulthood, participation in society and long-term wellbeing become central outcomes for both patients and families. Another area where evidence remains limited concerns diagnostic tools used in follow-up care. Although several reviews evaluated developmental assessment scales or imaging techniques, none met the methodological quality criteria required for guideline recommendations. This lack of robust evidence may partly explain the considerable variation in follow-up practices observed across different countries and healthcare systems. Beyond its findings, the study by Kaiser and colleagues also illustrates the methodological challenges faced during guideline development. When research questions are intentionally broad—as is often necessary when developing comprehensive guidelines, the volume of literature can become overwhelming 12. The authors addressed this challenge by introducing a hierarchical preliminary screening strategy that allowed them to rapidly identify reviews most likely to provide reliable evidence. This pragmatic approach may prove useful for other guideline developers facing similar challenges. The implications of this work extend beyond the specific field of preterm follow-up care. The study serves as a reminder that the quantity of research does not automatically guarantee its usefulness for clinical decision-making. High-quality systematic reviews require rigorous methods, transparent reporting and adherence to established methodological standards. Without these elements, even well-intentioned research risks contributing more noise than clarity to scientific literature. Ultimately, improving outcomes for children born preterm requires a continuum of care that extends far beyond the neonatal intensive care unit. Neonatal medicine has succeeded in saving increasingly fragile infants; the next challenge lies in ensuring that these survivors thrive throughout childhood and into adulthood 13, 14. Achieving this goal will depend not only on clinical innovation but also on a stronger and more reliable evidence base 15. The mapping review by Kaiser et al. provides an important step in this direction. By illuminating both the strengths and weaknesses of existing literature, the study encourages a more critical approach to evidence synthesis and highlights the areas where future research is most urgently needed. The message is clear for all researchers and clinicians: generating evidence is not enough; instead, the focus should be on the quality and the relevance for clinical practice. Ilari Kuitunen: conceptualization, writing – review and editing, writing – original draft. The author declares no conflicts of interest. Identification and Assessment of Systematic Reviews for Evidence-Based Guideline Recommendations on Follow-Up of Preterm Born Children: A Mapping Review, https://doi.org/10.1111/apa.70507. The author has nothing to report.