The Hierarchy of Evidence

The Hierarchy of evidence is based on summaries from the National Health and Medical Research Council (2009), theOxford Centre for Evidence-based Medicine Levels of Evidence (2011) and Melynyk andFineout-Overholt (2011).

ΙEvidence obtained from a systematic review of all relevant randomised control trials.

ΙΙEvidence obtained from at least one well designed randomised control trial.

ΙΙΙEvidence obtained from well-designed controlled trials without randomisation.

IVEvidence 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

VEvidence obtained from systematic reviews of descriptive and qualitative studies

VIEvidence obtained from single descriptive and qualitative studies

VIIExpert 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 (2nded.). Philadelphia: WoltersKluwer, 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.

OCEBM Levels of Evidence Working Group Oxford (2011).The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine.

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Reference (include title, author, journal title, year of publication, volume and issue, pages) / Evidence level
(I-VII) / Key findings, outcomes or recommendations
  1. Akre J. Infant feeding; thephysiological basis, Geneva,WHO, 1989
/ Textbook / Benefits to infant and mother
  1. 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
  1. National Health and Medical Research Council, Infant Feeding Guidelines 2012: Canberra.
/ NHMRC guidelines / Economic and social benefits
  1. 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
  1. HoddinottP,Tapin D, Wright C. Breast feeding,BMJ,2008;336;881-7
/ lll / Overview and practical aspects of breastfeeding
  1. 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
  1. 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
  1. 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
  1. Britton, C., et al., Support for breastfeeding mothers. Cochrane Database Syst Rev, 2007(1): p. CD001141.
/ I / Support for breastfeeding mothers
  1. The Royal WomensHospital Breastfeeding,Best Practice guidelines
/ Clinical guidelines / Practical guidelines
  1. World Health Organization (1981). International code of marketing of breast-milk substitutes Geneva
/ Code of marketing / Code of marketing
  1. World Health Organization (2008). International code of marketing of breast milk substitutes - Frequently asked questions updated 2008. France
/ Code of marketing / Code of marketing
  1. Academy of Breastfeeding Medicine (2010). "Clinical Protocol 8: Human milk storage information for home use for full-term infants”. Breastfeeding Medicine5(3): 127-130.
/ VII / Transport and storage of EBM
  1. Slutzah M, Codipilly C, Potak D. (2010) Refrigerator storage of expressed human milk in the neonatal intensive care unit. J Pediatr156:26-28
/ VI
Supported by NHMRC guidelines / Transport and storage of EBM
  1. Rechtman, D. J., et al. (2006). "Effect of environmental conditions on unpasteurized donor human milk." Breastfeed Med1(1): 24-26.
/ VI / Transport and storage of EBM
  1. RCH anaesthesia and painmanagement website
/ Clinical guidelines / Parents information regarding recommended fasting times
  1. Giglia RC. Alcohol and lactation: an updated systematic review. Nutr Diet 2010;67(4):237–43.
/ III / Effect of alcohol on lactation
  1. 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
  1. National Library of Medicine. Drugs and lactation database (LactMed). 2011 (cited 19/6/13).
/ / Effect of drugs on lactation

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