Clinical practice guidelines for neonatal hypoxic-ischemic encephalopathy: A systematic review using the appraisal of guidelines for research and evaluation (AGREE) II instrument

Yasser S Amer; Jasim Anabrees; Mohamed Abdelmawla; Ayman Abdalgader; Asmaa Almazroei; Ibrahim Alhifzi; Abdullah Hawash AlOnazi; Yasser Sabr; Layal Hneiny; Ahmed El-Malky; Ayesha Alshalawi; Ahmed Alayoubi; Iftikhar A Chaudhry; Omar Elkhateeb

doi:10.3389/fped.2023.1092578

Clinical practice guidelines for neonatal hypoxic-ischemic encephalopathy: A systematic review using the appraisal of guidelines for research and evaluation (AGREE) II instrument

Front Pediatr. 2023 Mar 22:11:1092578. doi: 10.3389/fped.2023.1092578. eCollection 2023.

Authors

Yasser S Amer^{1

2

3

4

5}, Jasim Anabrees^{6

7}, Mohamed Abdelmawla⁸, Ayman Abdalgader⁹, Asmaa Almazroei⁸, Ibrahim Alhifzi¹⁰, Abdullah Hawash AlOnazi¹¹, Yasser Sabr¹², Layal Hneiny¹³, Ahmed El-Malky^{14

15}, Ayesha Alshalawi¹⁶, Ahmed Alayoubi¹⁷, Iftikhar A Chaudhry¹⁸, Omar Elkhateeb¹¹

Affiliations

¹ Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia.
² Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia.
³ Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.
⁴ Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.
⁵ Adaptation Working Group, Guidelines International Network, Perth, Scotland.
⁶ Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁷ Saudi Neonatology Society (SNS), Riyadh, Saudi Arabia.
⁸ Pediatrics Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
⁹ Neonatology Department, Pediatric Hospital, King Saud Medical City, Riyadh, Saudi Arabia.
¹⁰ The Specialist Hospital-Abha, Abha, Saudi Arabia.
¹¹ Neonatal Intensive Care Unit, Critical Care Services, King Fahad Medical City, MOH, Riyadh, Saudi Arabia.
¹² Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹³ Wegner Health Sciences Library, University of South Dakota, Sioux Falls, SD, United States.
¹⁴ Morbidity and Mortality Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
¹⁵ Public Health and Community Medicine Department, Theodor Bilharz Research Institute (TBRI), Academy of Scientific Research, Cairo, Egypt.
¹⁶ Nursing Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.
¹⁷ Pediatric Department, Umm Al Qura University, Makkah, Saudi Arabia.
¹⁸ Obstetrics and Gynecology Department, Al-Yamamah Hospital, Ministry of Health, Riyadh, Saudi Arabia.

Abstract

Background and objective: To systematically review, critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal hypoxic ischemic encephalopathy (HIE), and map their recommendations.

Data sources: CPG databases (GIN, ECRI, NICE, SIGN, DynaMed), Bibliographic databases (PubMed, Embase, CINAHL), and related specialized professional societies (e.g., AAP, CPS, BAPM, RCPCH, and SNS).

Study selection: Original de-novo developed evidence-based CPGs for HIE, group authorship, Arabic or English languages, and international or national scope. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and Johnston et al methodological guide.

Data extraction: Quality assessment of the included HIE CPGs by the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) Instrument and report their characteristics, AGREE II ratings, and recommendations.

Data synthesis: Our search retrieved 2,489 citations, of which two recent HIE CPGs were eligible and appraised: Canadian Paediatric Society (CPS) and Queensland Maternity and Neonatal Services (QMN). The overall assessment of the QMN CPG was superior (83%). Domain 1 (Scope & Purpose) scored (47%, 63%), Domain 2 (Stakeholder Involvement) (72%, 39%), Domain 3 (Rigour of Development) (48%, 43%), Domain 4 (Clarity & Presentation) (100%, 96%), Domain 5 (Applicability) (59%, 9%), and Domain 6 (Editorial Independence) (67%, 17%) for the QMN and CPS CPGs respectively. All appraisers recommended the QMN CPG for use in practice.

Conclusion: The methodological quality of the QMN CPG was superior with the relevant recommendations for its use in neonatal practice.

Limitations: limited to Arabic and English languages.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258291, identifier: CRD42021258291.

Keywords: AGREE II instrument; HIE; clinical practice guidelines; hypoxic ischemic encephalopathy; neonatology; pediatrics; quality assessment; systematic review.

Publication types

Review

Grants and funding

This study was funded by the Saudi Neonatology Society (SNS).