Systematic Review and Quality Appraisal of International Guidelines on Perinatal Care of Extremely Premature Infants
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.092 | 0.382 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.012 | 0.007 |
| Bibliometrics | 0.033 | 0.027 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".