Systematic Review and Quality Appraisal of International Guidelines on Perinatal Care of Extremely Premature Infants
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Navneet Binepal, Brigitte Lemyre, Sandra Dunn
1Ottawa Hospital, General Campus, Division of Newborn Services, Box 806, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6. gmoore@cheo.on.ca.
Insights
Published international guidelines for perinatal care of extremely premature infants (22-25 weeks gestation) show significant quality deficits. Rigorous and transparent guideline development is needed to improve clinical practice.
Area of Science:
- Perinatal Medicine
- Evidence-Based Practice
- Healthcare Guideline Development
Background:
- Clinicians rely on guidelines for perinatal care decisions at the limits of viability.
- Current guidelines inform expectant parents on complex choices for extremely premature infants.
Purpose of the Study:
- To systematically review and assess the quality of international guidelines for perinatal care of infants aged 22-25 weeks gestation.
- Evaluate adherence to established quality standards in published guidelines.
Main Methods:
- Systematic literature search of MEDLINE, Pre-MEDLINE, and TRIP databases.
- Inclusion of guidelines from institutions with expertise in extreme prematurity, offering comprehensive care, and published post-1999.
- Quality appraisal using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) tool.
Main Results:
- 16 international guidelines met inclusion criteria from 263 initial publications.
- All appraised guidelines exhibited quality deficits across AGREE-II domains, notably in Applicability, Editorial Independence, and Rigour of Development.
- Overall guideline quality scores ranged from 11%-61%, with none deemed suitable for use without modifications.
Conclusions:
- Published international guidelines for perinatal care of 22-25 week gestational age infants demonstrate significant quality deficits.
- There is a critical need for the development of more rigorous and transparent guidelines to effectively inform clinical practice in this area.
Objectives:
Clinicians often refer to published or local guidelines when counselling expectant parents on perinatal care decisions at the limits of viability. The objectives of this study are to systematically review the literature and assess the quality of published international guidelines regarding perinatal care of 22-25 week gestational age infants.
Study Design:
MEDLINE, Pre-MEDLINE and TRIP databases were systematically searched for guidelines on perinatal management of extremely premature infants. Included guidelines were: created by an institution that regularly cared for extremely premature infants; offered comprehensive care plans; and, published after 1999 in English. The final selected guidelines were appraised using the validated AGREE-II (Appraisal of Guidelines for Research & Evaluation) tool which consists of six quality domains (Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability, and Editorial Independence). Overall guideline quality was rated and each appraiser was asked whether they recommended the guideline for use.
Results:
Electronic and grey searches yielded 263 publications. Screening left 37 guidelines, 16 of which met inclusion criteria. Appraisal revealed deficits within all quality domains, predominantly 'Applicability', 'Editorial Independence' and 'Rigour of Development'. A wide range of mean domain scores within each guideline was observed. Overall quality scores ranged from 11%-61%; no guideline was assessed as suitable for use without modifications.
Conclusion:
Based on the AGREE-II criteria, we identified deficits in the quality of all of the published international guidelines, highlighting the need for rigorously and transparently developed guidelines to inform practice related to perinatal care of 22-25 week gestational age infants.
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