新生儿脐带结扎时间相关临床实践指南的系统评价

Systematic evaluation of clinical practice guidelines on neonatal umbilical cord clamping time

目的:对新生儿脐带结扎时间相关临床实践指南进行质量评价和内容分析,旨在了解有关脐带结扎时间指南的主要问题,为脐带结扎时间的规范管理提供依据。方法:检索PubMed、EmBase和Web of Science数据库,以及指南数据库中的新生儿脐带结扎相关临床实践指南,使用Excel 2013提取指南的基本信息、方法学和报告质量;使用AGREEⅡ和RIGHT工具评价指南的方法学和报告质量,汇总新生儿脐带结扎时间管理的推荐意见。结果:共纳入8部指南。AGREEⅡ的6个领域(范围和目的、参与人员、严谨性、明晰性、应用性、独立性)的得分分别为72.57±19.27、51.72±19.24、48.60±26.57、70.14±15.33、40.18±25.18、45.84±31.32,RIGHT的“证据和推荐意见”领域、“资金资助与利益冲突声明和管理”领域存在不足。其中2部指南符合推荐临床使用的标准,6部指南为修改后推荐使用。关于脐带结扎时间,指南的推荐意见为提倡延迟,但是存在不一致。结论:不同机构指南对新生儿脐带结扎时间的建议存在争议,指南方法学质量差别较大,指南制订的严谨性、应用性和独立性有待提高,指南制订者应严格按照国际标准进行指南的制订和报告,提高临床实践指南的质量。

Objective To investigate the major problems in umbilical cord clamping time by evaluating the clinical practice guidelines on neonatal umbilical cord clamping time and analyzing their contents in order to provide the evidence for their standardized management.Methods The clinical practice guidelines on neonatal umbilical cord clamping time were retrieved from the PubMed,EmBase,Web of Science and Guidelines databases,their basic information,methodology and report quality were extracted using Excel 2013,their methodology and report quality were evaluated using the AGREEⅡand RIGHT tools,the recommendations for neonatal umbilical cord clamping time were summarized.Results Eight clinical practice guidelines on neonatal umbilical cord clamping time were included in this study.The score of 6 AGREEⅡdomains(scope and goal,participants,rigorousness,distinctness,applicability and independence)was 72.57±19.27、51.72±19.24、48.60±26.57、70.14±15.33、40.18±25.18 and 45.84±31.32 respectively.There were limitations in the"evidence and recommendations"domain and"fund support and interest conflict statement and management domain"of RIGHT.Of the 8 clinical practice guidelines on neonatal umbilical cord clamping time,2 meet the criteria for recommended clinical use and 6 meet the criteria for recommended clinical use after revision.The recommendations of the guidelines are to delay the neonatal umbilical cord clamping time,but they are inconsistent.Conclusion The neonatal umbilical cord clamping time,recommended by the guidelines worked out by different institutions is controversial,the quality of their methodology is different,and the rigorousness,applicability and independence need to be improved,and formulators of the guidelines should thus work out and report of the guidelines are strictly in accordance with the international standards.