Science

Evidence-based Guidelines Process

In 1998 the NRP Steering Committee of the American Academy of Pediatrics and the Pediatric Subcommittee of the American Heart Association began working together to review the pediatric resuscitation scientific literature. Committee members and colleagues evaluated the quality of evidence that exists to support current neonatal resuscitation practices and to suggest changes in them. This process involved the critical review of hundreds of published articles relating to all aspects of neonatal resuscitation, from the initial step of providing the proper thermal environment to advanced interventions, such as epinephrine administration and volume expansion.

Members of the committee were assigned specific topics to review. Once reviewers identified the most critical research in their topic area, they prepared comprehensive worksheets that rated and weighted the strength of published studies and determined the class of recommendation to support the existing or proposed guidelines.

The guidelines proposals were debated in September 1999 at the Evidence Evaluation (E2) Conference in Dallas, TX. At the conference, individuals who prepared worksheets, content experts, and invited guests participated in a number of topic specific panels to discuss and debate the level of evidence and class recommendations for proposed guidelines.

In February 2000 the content experts meet again to further discuss the recommendations made at E2 and produce final statements for the Emergency Cardiovascular Care Committee.

The culmination of this first evidence evaluation process was the publication of the Guidelines 2000 for Emergency Cardiovascular Care and Resuscitation: International Consensus on Science, which was published as a supplement to the journal Circulation on August 22, 2000.

In December 2003, more than 35 neonatologists and health care professionals from 10 countries convened in Washington, DC for an intensive, two-day meeting of the International Liaison Committee on Resuscitation Neonatal Delegation (ILCOR Neonatal Delegation) to critically analyze the new scientific data published since the 2000 guidelines and determine new international resuscitation recommendations.

The ILCOR Neonatal Delegation was comprised of representatives from the following groups:

• Australian Resuscitation Council (ARC)
• Council of Latin America for Resuscitation (CLAR)
• European Resuscitation Council (ERC)
• Heart and Stroke Foundation of Canada (HSFC)
• New Zealand Resuscitation Council (NZRC)
• Resuscitation Council of South Africa (RCSA)
• World Health Organization (WHO)
• American Academy of Pediatrics/American Heart Association NRP Steering Committee

Following the 2003 meeting, the members continued to research and refine their worksheets for presentation at the ILCOR Evidence Evaluation Conference in Dallas, TX in January 2005. At this meeting the ILCOR Neonatal Delegation reached consensus on 10 broad neonatal resuscitation issues. As a result of this enormous effort, the new Consensus on Science and Treatment Recommendations reflect a very thorough and evidence-based review of the key interventions that might be required to resuscitate a newborn infant in the delivery room.

View the 2005 evidence-based worksheets (http://www.americanheart.org/presenter.jhtml?identifier=3026177)

The ILCOR Consensus on Science and Treatment Recommendations was published in November 2005 in Circulation and reprinted in Pediatrics in May 2006.

The AHA Guidelines for CPR and ECC were published in Circulation in December 2006. The pediatric and neonatal portions of the guidelines were also reprinted in Pediatrics in May 2006. The neonatal portion of the guidelines is included as an appendix in the Textbook of Neonatal Resuscitation, 5th Edition.