Evidence based neonatology


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Opening lecture in Port said third neonatology conference, 18 & 19 October, 2012, by Osama Hussein

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Evidence based neonatology

  2. 2. EVIDENCE BASED “I will prescribe regimens for the good ofmy patients according to my ability and my NEONATOLOGYjudgment and never do harm to anyone.”
  3. 3. In the past, doctors didnt always have access to the latestmedical research. They often used to decide how to treatpatients using only their own judgment and experience, andwhat they learnt at medical school. We now know that this isnot the best way to practice medicine. This is because whatdoctors think is best for a patient is not always what is bestwhen you actually look at the research.When researchers study a disease or a condition, they look atmany more patients than a doctor will ever treat. Also,medical knowledge changes all the time. And what doctorsused to think was the best thing to do, even a few years ago,might actually be considered harmful today.Only by looking at all the evidence and judging it fairly canyou work out what the research really says about a treatment.This is called practicing evidence-based medicine
  4. 4. Randomized Controlled Double Blind Studies Randomized Controlled Studies Case Controlled Studies Case Series Case StudiesIdeas, Editorials, Opinions Animal Research In Vitro Research
  5. 5. Evidence-Based Medicine came to the fore in theearly 1990s and has become a major driving forcefor many national healthcare organizations. Theterm and concept originated at McMasterUniversity. It has been defined as "the integrationof best research evidence with clinical expertiseand patient values" (Sackett, 2000).
  6. 6. Best external evidenceIndividual Patient clinical values & expertise expectations
  7. 7. Fifty years ago, women were often given an enemawhile they were in labour. This is uncomfortable andunpleasant. But doctors thought that enemas wouldreduce the risk of infection for the woman and herbaby. Some hospitals gave soapy enemas, which werepainful for women. When doctors studied the resultsfrom the research, they found there was no evidencethat enemas prevented infections. Two studies showedthat enemas made more of a mess, and women feltembarrassed by the enema. Women no longer haveenemas while theyre in labourCuervo LG, Rodriguez MN, Delgado MB. Enemas during labor (Cochranereview). In: The Cochrane Library, Issue 2, 2000. Update Software, Oxford, UK.
  8. 8. BMJ. 2008 Sep 9;337:a1490. doi: 10.1136/bmj.a1490.Paracetamol plus ibuprofen for the treatment of fever in children : economicevaluation of a randomized controlled trial.Hollinghurst S, Redmond N, Costelloe C, Montgomery A, Fletcher M, Peters TJ,Hay AD.OBJECTIVE:To estimate the cost to the NHS and to parents and carers of treating febrilepreschool children with paracetamol, ibuprofen, or both, and to comparethese costs with the benefits of each treatment regimen.MAIN OUTCOME MEASURES:Costs to the NHS and to parents and carers. Cost consequences analysis at 48hours and 5 days comparing cost with childrens temperature, discomfort,activity, appetite, and sleep; cost effectiveness analysis at 48 hours comparingcost with percentage of children "recovered.“CONCLUSIONS:There is no strong evidence of a difference in cost between the treatments, butclinical and cost data together indicate that using both drugs together may bemost cost effective over the course of the illness. This treatment optionperforms best and is no more expensive because of less use of healthcareresources, resulting in lower costs to the NHS and to parents.
  9. 9. Thousands of premature babies died becauseantipartum corticosteroids was not widely used. In1972, the first of several studies was published showingthat giving corticosteroids to women about to have apremature baby could protect the baby fromrespiratory distress syndrome. But it was another 20years before obstetricians began using thesecorticosteroids regularly.Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoidtreatment for prevention of the respiratory distress syndrome in prematureinfants. Pediatrics. 1972; 50: 515-525.
  10. 10. High flow nasal cannula for neonatal respiratory disordersThere is growing evidence of the feasibility of HFNC as analternative to other forms of non-invasive ventilation inpreterm infants. However, there remains uncertainty aboutthe efficacy and safety of HFNC in this population. Until theresults of larger randomized trials are known, widespread useof HFNC to treat preterm infants cannot be recommended.(Manley, 2012)Based on the results of this review there is insufficientevidence to determine whether or not HFNC is safe oreffective as a form of respiratory support in preterm infants.When used following extubation, HFNC may be associatedwith a higher rate of reintubation than nasal CPAP. (Cochrane,2012)
  11. 11. Animal-derived surfactants have been shown to besuperior to synthetic surfactant without proteins(Chochrane, 2009). When bovine and porcinederived surfactant preparations were compared,data were favoring the porcine derived surfactantin 5 randomized controlled trials and tworetrospective studies (Pediatrics, 2011). Yet insome Islamic countries it is not desired to useporcine derived surfactant.
  12. 12. The Cochrane Collaboration is a major force in the EBMmovement. It was created as a response to a call byArchie Cochrane, a British epidemiologist, to developup-to-date systematic reviews of randomized controlledtrials from all areas of health care the best availableevidence could be made available as a basis for makinghealthcare decisions. The first Cochrane Centre wasopened in Oxford in
  13. 13. Using amp & Gent combination El Nasr NICU, Port said, Egypt amp&gent total amp & others
  14. 14. nights/casenights/case
  15. 15. mort/admmort/adm El Nasr NICU, Port said, Egypt
  16. 16. EVIDENCE BASED MEDICINE ADVANTAGES • It offers the surest and most objective way to determine and maintain consistently high quality 1 and safety standards in medical practice • It can help speed up the process of transferring clinical research findings into practice 2 • It has the potential to reduce health-care costs significantly 3
  17. 17. Im not a handsome guy, but i can givemy Hand-to-some guy who needs help