Effectiveness of combined versus single circadian interventions in neonatal and pediatric intensive care units: a systematic review with meta-analysis
Abstract
Introduction: Admission to neonatal or pediatric intensive care units exposes vulnerable patients to confounding environmental cues, disrupting circadian rhythms and potentially compromising physiological stability. While various circadian interventions exist, ranging from simple light cycling to complex multicomponent bundles, it remains unclear whether complex bundles offer superior clinical benefits over single-modality interventions. This systematic review evaluated the efficacy of circadian interventions on physiological parameters and sleep primarily in critically ill neonates and children, specifically comparing single versus combined strategies.
Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. We searched five major electronic databases: PubMed, ScienceDirect, CINAHL, WoS, Scopus and LILACS. Additionally, the Epistemonikos and SciELO databases were screened to identify relevant studies published in languages other than English. The search covered from inception to 2025 and was conducted during October 2025. Risk of bias was assessed using the Cochrane RoB 2 tool and ROBINS-I, while the certainty of evidence was evaluated using the GRADE approach. Data were synthesized using random-effects meta-analysis for physiological outcomes and SWiM guidelines for studies with non-parametric or incompatible data.
Results: Forty-one studies (N = 2,548) met the inclusion criteria. Meta-analysis of 16 studies demonstrated that…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,548 participants or records.
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