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Guideline: Neonatal Vitamin A Supplementation. Geneva: World Health Organization; 2011.

Cover of Guideline: Neonatal Vitamin A Supplementation

Guideline: Neonatal Vitamin A Supplementation.

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Guideline development process

This guideline was developed in accordance with the WHO evidence-informed guideline development procedures, as outlined in the WHO handbook for guideline development (24).

Advisory groups

A WHO/United Nations Children's Fund (UNICEF) Steering Committee for Guidelines on Vitamin A Supplementation was established in 2009 with representatives from the WHO departments of Child and Adolescent Health and Development; Immunizations, Vaccines and Biologicals; Making Pregnancy Safer; Nutrition for Health and Development; Reproductive Health and Research; and the Nutrition Section of UNICEF (Annex 2). The Steering Committee guided the development of this guideline and provided overall supervision of the guideline development process. Two additional groups were formed: an advisory guideline group and an External Experts and Stakeholders Panel.

The Vitamin A Supplementation Guideline Group included experts from various WHO expert advisory panels and those identified through open calls for specialists, taking into consideration a balanced gender mix, multiple disciplinary areas of expertise and representation from all WHO regions (Annex 3). Efforts were made to include content experts, methodologists, representatives of potential stakeholders (such as managers and other health professionals involved in the health-care process) and consumers. Representatives of commercial organizations may not be members of a WHO guideline group. The role of the guideline group was to advise WHO on the choice of important outcomes for decision-making and the interpretation of the evidence.

The External Experts and Stakeholders Panel was consulted on the scope of the document, the questions addressed and the choice of important outcomes for decision-making, as well as with regard to review of the completed draft guideline (Annex 4). This was done through the WHO Micronutrients and SCN mailing lists, which together include over 5500 subscribers, and through the WHO nutrition web site.

Scope of the guideline, evidence appraisal and decision-making

An initial set of questions (and the components of the questions) to be addressed in the guideline was the critical starting point for formulating the recommendation; the questions were drafted by technical staff at the Micronutrients Unit, Department of Nutrition for Health and Development, in collaboration with the Nutrition Section of UNICEF, based on policy and programme guidance needs of Member States and their partners. The population, intervention, control, outcomes (PICO) format was used (Annex 5). The questions were discussed and reviewed by the Steering Committee and feedback was received from 45 stakeholders.

The first guideline group meeting was held on 19–20 October 2009 in Geneva, Switzerland, to finalize the scope of the questions and rank the critical outcomes and populations of interest. The guideline group members discussed the relevance of each question and modified them as needed. They scored the relative importance of each outcome from 1 to 9 (where 7–9 indicated that the outcome was critical for a decision, 4–6 indicated that it was important and 1–3 indicated that it was not important). The final key question on neonatal vitamin A supplementation, along with the outcomes that were identified as critical for decision-making, are listed in PICO format in Annex 5.

The Cochrane Collaboration was commissioned to search, review and generate systematic reviews, evidence profiles and the “Summary of findings” table1 (Annex 1). Two existing reviews on vitamin A supplementation in neonates were updated, and the up-to-date Review Manager Software (RevMan) files, obtained from the Cochrane Editorial Unit, were customized in order to reflect the critical outcomes previously identified (outcomes not relevant to this guideline were excluded). The RevMan files were exported to the GRADE profiler software in order to prepare the evidence summaries according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for assessing the overall quality of the available evidence (25) (Annex 1). GRADE considers: the study design; the limitations of the studies in terms of their conduct and analysis; the consistency of the results across the available studies; the directness (or applicability and external validity) of the evidence with respect to the populations, interventions and settings where the proposed intervention may be used; and the precision of the summary estimate of the effect.

Both the systematic reviews and the GRADE evidence profiles for each of the critical outcomes were used for drafting the guideline. A second guideline group meeting was held on 16–18 March 2011, in Geneva, Switzerland, to review the evidence, discuss the draft recommendation and to determine its strength, taking into consideration: (i) desirable and undesirable effects of this intervention; (ii) the quality of the available evidence; (iii) values and preferences related to the intervention in different settings; and (iv) the cost of options available to health-care workers in different settings (Annex 6). Consensus was defined as agreement by simple majority of the guideline group members. WHO staff present at the meeting as well as other external technical experts involved in the collection and grading of the evidence were not allowed to vote. There were no strong disagreements among the guideline group members.

The External Experts and Stakeholders Panel was again consulted on the draft guideline. Feedback was received from 12 stakeholders. WHO staff then finalized the guideline and submitted it for clearance by WHO before publication.

As part of the Cochrane pre-publication editorial process, reviews are commented on by external peers (an editor, and two referees who are external to the editorial team) and the group's statistical adviser (http://www​.cochrane.org/cochrane-reviews). The Cochrane handbook for systematic reviews of interventions describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of health-care interventions.

Footnotes

1

As part of the Cochrane pre-publication editorial process, reviews are commented on by external peers (an editor, and two referees who are external to the editorial team) and the group's statistical adviser (http://www​.cochrane.org/cochrane-reviews). The Cochrane handbook for systematic reviews of interventions describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of health-care interventions.

Copyright © World Health Organization 2011.

All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html).

Bookshelf ID: NBK185156
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