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

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.

Building a community of practice through social media using the hashtag #neoEBM.

OBJECTIVES: Social media use is associated with developing communities of practice that promote the rapid exchange of information across traditional institutional and geographical boundaries faster than previously possible. We aimed to describe and share our experience using #neoEBM (Neonatal Evidence Based Medicine) hashtag to organise and build a digital community of neonatal care practice. MATERIALS AND METHODS: Analysis of #neoEBM Twitter data in the Symplur Signals database between 1 May 2018 to 9 January 2021. Data on tweets containing the #neoEBM hashtag were analysed using online analytical tools, including the total number of tweets and user engagement. RESULTS: Since its registration, a total of 3 228 distinct individual Twitter users used the hashtag with 23 939 tweets and 37 259 710 impressions generated. The two days with the greatest number of tweets containing #neoEBM were 8 May 2018 (n = 218) and 28 April 2019 (n = 340), coinciding with the annual Pediatric Academic Societies meeting. The majority of Twitter users made one tweet using #neoEBM (n = 1078), followed by two tweets (n = 411) and more than 10 tweets (n = 347). The number of individual impressions (views) of tweets containing #neoEBM was 37 259 710. Of the 23 939 tweets using #neoEBM, 17 817 (74%) were retweeted (shared), 15 643 (65%) included at least one link and 1 196 (5%) had at least one reply. As #neoEBM users increased over time, so did tweets containing #neoEBM, with each additional user of the hashtag associated with a mean increase in 7.8 (95% CI 7.7-8.0) tweets containing #neoEBM. CONCLUSION: Our findings support the observation that the #neoEBM community possesses many of the characteristics of a community of practice, and it may be an effective tool to disseminate research findings. By sharing our experiences, we hope to encourage others to engage with or build online digital communities of practice to share knowledge and build collaborative networks across disciplines, institutions and countries.

Outcomes of neonates born at <26 weeks gestational age who receive extensive cardiopulmonary resuscitation compared with airway and breathing support.

OBJECTIVE: To evaluate outcomes of preterm infants <26 weeks gestational age (GA) following postdelivery extensive cardiopulmonary resuscitation (ECPR) compared with airway and breathing support (ABS). STUDY DESIGN: Retrospective review of Canadian Neonatal Network data during January 2010 to December 2016. The primary outcome was death or severe morbidity (intraventricular hemorrhage ≥grade 3 or periventricular leucomalacia, retinopathy of prematurity ≥stage 3, bronchopulmonary dysplasia, or necrotizing enterocolitis). RESULT: Among 3633 infants analyzed, 433 (11.9%) received ECPR. In multivariable analysis, death or severe morbidity was higher in the ECPR versus ABS group [adjusted odds ratio 2.26 (95% confidence interval 1.49, 3.43)]. The majority of the difference was due to increased mortality, which occurred mostly during the first week of life. CONCLUSION: These data from a recent cohort of infants near the limits of viability may be useful for prognostication for health care providers and counseling of parents.