title: Systematic Review and Quality Appraisal of International Guidelines on Perinatal Care of Extremely Premature Infants.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Navneet
authors.initials: N
authors.lastname: Binepal
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lemyre
authors.forename: Sandra
authors.initials: S
authors.lastname: Dunn
authors.forename: Thierry
authors.initials: T
authors.lastname: Daboval
authors.forename: Mary
authors.initials: M
authors.lastname: Aglipay
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leduc
authors.affiliation: Ottawa Hospital, General Campus, Division of Newborn Services, Box 806, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6. gmoore@cheo.on.ca.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Moore
mesh_terms: D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic / Q000592:standards*