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Publication Detail
Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique (preprint)



To determine whether a panel of neonatal experts could address evidence gaps in neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree).


Two-round, modified Delphi technique.

Setting and participants

Participants were neonatal experts from high-income and low-income countries (LICs).


This was a consensus-generating study. In round one, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus (≥80% agreement) were included. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round two, experts rated items from round one that did not reach consensus.


Fourteen experts participated in round one, ten in round two. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Experts consistently stated that items must be in line with local and WHO guidelines (irrespective of the level of supporting evidence or expert opinion). As a result, the final algorithms included 53 items (62%).


Four algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to the NeoTree application were made in response to these findings and will be clinically validated in an imminent study.


➢ In this study, a large number of algorithm items were reviewed and evaluated, and half met consensus for inclusion in the management pathways. ➢ The review was conducted with experts from a broad range of countries and neonatal experience who simultaneously refined the algorithms and highlighted gaps in current evidence, emphasising the need for future research to support international neonatal guidelines. ➢ Our study method meant that experts were not able to meet in person, which might have promoted dialogue that would have allowed greater clarity in their collective opinion. ➢ The representation of neonatal experts from LICs was not as robust as from high-income countries, which may have led to an uneven evaluation of the algorithms.
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