{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:50:58Z","timestamp":1791294658233,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We conducted a systematic review and prognostic meta\u2010analysis to evaluate the association between ultrasound\u2010derived measures of diaphragm structure and contractile activity with the risk of extubation failure in mechanically ventilated neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>MEDLINE, Embase, the Cochrane Library, CINAH, Scopus, and ClinicalTrials.gov were systematically searched from inception to January 12, 2026, without using language restrictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection<\/jats:title>\n                    <jats:p>Observational studies including mechanically ventilated neonates (\u2264\u200928 days old) undergoing planned extubation in whom diaphragmatic thickness, thickening fraction, or excursion were measured by ultrasound and extubation outcome were reported. Studies involving congenital diaphragmatic or neuromuscular disorders were excluded. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random\u2010effects meta\u2010analyses were conducted using mean differences (MD) with 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1,522 records identified, 110 full\u2010text articles were assessed, and seven prospective cohort studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009255 neonates) met the inclusion criteria. Extubation failure occurred in 90 neonates (35%). Neonates who failed extubation had significantly lower diaphragm thickening fraction compared with those successfully extubated (MD = \u22129.51%; 95% CI: \u221214.73 to \u22124.29;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004; I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Differences in diaphragm thickness and excursion were not statistically significant. Overall risk of bias was moderate to high, primarily due to inadequate adjustment for confounding and variability in outcome definitions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower diaphragm thickening fraction is associated with extubation failure in mechanically ventilated neonates. Standardization of measurement protocols and prospective validation studies are needed before diaphragm ultrasound can be incorporated into routine extubation decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION<\/jats:title>\n                    <jats:p>PROSPERO CRD420251045024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71807","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:21:11Z","timestamp":1787649671000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Diaphragm Ultrasound Measures and Extubation Outcomes in Neonates: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-5107","authenticated-orcid":false,"given":"Mayson L. A.","family":"Sousa","sequence":"first","affiliation":[{"name":"Department of Respiratory Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"},{"name":"Children's Hospital Research Institute of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-4457","authenticated-orcid":false,"given":"Eleonora","family":"Balzani","sequence":"additional","affiliation":[{"name":"Centre for Medical Sciences\u2010CISMed University of Trento Trento Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3206-0433","authenticated-orcid":false,"given":"Sebastian","family":"Dubo","sequence":"additional","affiliation":[{"name":"Departamento de Kinesiolog\u00eda, Facultad de Medicina Universidad de Concepci\u00f3n Concepci\u00f3n Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda A. C.","family":"Coelho","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Fisioterapia, Instituto do Cora\u00e7\u00e3o Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glasiela","family":"Alcala","sequence":"additional","affiliation":[{"name":"Toronto General Hospital Research Institute Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Me\u2010Linh","family":"Le","sequence":"additional","affiliation":[{"name":"Neil John Maclean Health Sciences Library, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7279-5226","authenticated-orcid":false,"given":"Shyamala","family":"Dakshinamurti","sequence":"additional","affiliation":[{"name":"Children's Hospital Research Institute of Manitoba Winnipeg Manitoba Canada"},{"name":"Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, Max Rady College of Medicine University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Section of Neonatology, Department of Pediatrics University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4073-4001","authenticated-orcid":false,"given":"Annia F.","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4920-z"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/children12030273"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-019-0704-1"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.1022743"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-022-02223-4"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.02.016"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2017.330"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25383"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26598"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182266408"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-024-02103-z"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.4266\/ACC.2021.01354"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-04823-4"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-3687-3"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-03975-5"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chpulm.2025.100191"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wfumbo.2024.100033"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/08035250310004793"},{"key":"e_1_2_10_20_1","doi-asserted-by":"crossref","unstructured":"V. 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