Lack of Blinding May Affect Objective Outcomes in Trials on Neonatal Ventilation
Our response to the article by Kuitunen and colleagues titled "Blinding Assessments in Neonatal Ventilation Meta-Analyses: A Systematic Meta-Epidemiological Review." Article can be found here.
In their article, Kuitunen and colleagues argued that the significance of blinding in reviews on neonatal ventilation strategies has been exaggerated, leading to unwarranted reduction in the certainty of evidence. They propose that objective outcomes like mortality and bronchopulmonary dysplasia (BPD) should not be downgraded due to lack of blinding because "the knowledge of the intervention received does not impact outcome assessment."
We contend that this is not always the case, as clinicians may behave differently if they are aware of the allocation, such as adjusting caffeine dosage or altering ventilation strategies, particularly when these specifics are not standardized in the trial protocol.
While certain interventions, such as those involving bedside technologies like mechanical ventilation, therapeutic hypothermia, and extracorporeal membrane oxygenation, cannot be effectively blinded, it is important not to disregard the uncertainty introduced by the absence of blinding in evaluating these interventions. Nonetheless, we believe that the issue of outcomes being influenced by individual biases due to lack of blinding can be partially mitigated if intervention strategies, including co-interventions, are clearly standardized in the trial protocol to prevent any post hoc decisions.
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