The Hierarchy of Evidence
The Hierarchy of evidence is based on summaries from the National Health and Medical Research Council (2009), the Oxford Centre for Evidence-based Medicine Levels of Evidence (2011) and Melynyk and Fineout-Overholt (2011).
Ι Evidence obtained from a systematic review of all relevant randomised control trials.
ΙΙ Evidence obtained from at least one well designed randomised control trial.
ΙΙΙ Evidence obtained from well-designed controlled trials without randomisation.
IV Evidence obtained from well designed cohort studies, case control studies, interrupted time series with a control group, historically controlled studies, interrupted time series without a control group or with case- series
V Evidence obtained from systematic reviews of descriptive and qualitative studies
VI Evidence obtained from single descriptive and qualitative studies
VII Expert opinion from clinicians, authorities and/or reports of expert committees or based on physiology
Melynyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins.
National Health and Medical Research Council (2009). NHMRC levels of evidence and grades for recommendations for developers of guidelines (2009). Australian Government: NHMRC. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
OCEBM Levels of Evidence Working Group Oxford (2011).The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=1025
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(I-VII) / Key findings, outcomes or recommendations
1. Akre J. Infant feeding; the physiological basis, Geneva,WHO, 1989 / Textbook / Benefits to infant and mother
2. Horta, Evidence of the long-term effects of breastfeeding: systematic reviews and meta-analyses, 2007, World Health Organization Geneva / ll / Benefits to infant and mother
3. National Health and Medical Research Council, Infant Feeding Guidelines 2012: Canberra. / NHMRC guidelines / Economic and social benefits
4. Stuebe A, The Risks of Not Breastfeeding for Mothers and Infants. Rev Obstet Gynecol. , 2009. 2(4): p. 222-231. / ll / Risks of not breastfeeding
5. Hoddinott P,Tapin D, Wright C. Breast feeding, BMJ,2008;336;881-7 / lll / Overview and practical aspects of breastfeeding
6. Oddy, W.H., The long-term effects of breastfeeding on asthma and atopic disease. Adv Exp Med Biol, 2009. 639: p. 237-51. / lll / Benefits to infant
7. Barclay, A.R., et al., Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr, 2009. 155(3): p. 421-6. / lll / Benefits to infant
8. Kramer Ms, A.F.M.E. and et al., Breastfeeding and child cognitive development: New evidence from a large randomized trial. Archives of General Psychiatry, 2008. 65(5): p. 578-584. / ll / Cognitive development
9. Britton, C., et al., Support for breastfeeding mothers. Cochrane Database Syst Rev, 2007(1): p. CD001141. / I / Support for breastfeeding mothers
10. The Royal Womens Hospital Breastfeeding, Best Practice guidelines
http://www.thewomens.org.au/BreastfeedingBestPracticeGuidelines / Clinical guidelines / Practical guidelines
11. World Health Organization (1981). International code of marketing of breast-milk substitutes Geneva / Code of marketing / Code of marketing
12. World Health Organization (2008). International code of marketing of breast milk substitutes - Frequently asked questions updated 2008. France
/ Code of marketing / Code of marketing
13. Academy of Breastfeeding Medicine (2010). "Clinical Protocol 8: Human milk storage information for home use for full-term infants”. Breastfeeding Medicine 5(3): 127-130. / VII / Transport and storage of EBM
14. Slutzah M, Codipilly C, Potak D. (2010) Refrigerator storage of expressed human milk in the neonatal intensive care unit. J Pediatr 156: 26-28 / VI
Supported by NHMRC guidelines / Transport and storage of EBM
15. Rechtman, D. J., et al. (2006). "Effect of environmental conditions on unpasteurized donor human milk." Breastfeed Med 1(1): 24-26. / VI / Transport and storage of EBM
16. RCH anaesthesia and pain management website http://www.rch.org.au/anaes/healthinfo/index.cfm?doc_id=779 / Clinical guidelines / Parents information regarding recommended fasting times
17. Giglia RC. Alcohol and lactation: an updated systematic review. Nutr Diet 2010;67(4):237–43. / III / Effect of alcohol on lactation
18. Amir LH, Donath SM. Does maternal smoking have a negative physiological effect on breastfeeding? The epidemiological evidence. Birth 2002;29(2):112–23. / IV / Effect of smoking on lactation
19. National Library of Medicine. Drugs and lactation database (LactMed). 2011 (cited 19/6/13). / www.toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT / Effect of drugs on lactation
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