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.