Abstract

Introduction: the Grading of Recommendations Assessment Development and Evaluation (GRADE) is a system to formulate scientific recommendations that is still rarely used in Pediatrics. During years 2012 and 2013 a multidisciplinary group of Spanish health professionals elaborated a Clinical Practice Guideline (CPG) on hypoxic-ischemic encephalopathy (HIE) using this methodology.
Aims: to describe the phases followed in the development of this CPG pointing out strengths and weaknesses encountered.
Methods: the GRADE methodology was used in the CPG development.
Results: the main strengths identified were the establishment of recommendations in a transparent way and the incorporation of families opinions. The main difficulties found were: the long elaboration time required, question prioritization, necessity of performing three new metanalysis due to the scarce bibliography, inclusion of diagnostic tests and final synthesis of scientific evidence in only one recommendation. In order to include parents views we had to develop an original qualitative study.
Conclusions: a CPG on HIE encephalopathy using GRADE methodology has been developed. This methodology incorporates important advantages compared to others and allowed to close up with a recommendation to "make " or "no" to make a specific therapeutic or diagnostic action with a "strong" or "weak " intensity. We hope gained experience will be of help to others in the development of new CPG.