What’s the best way to manage a PDA? New evidence from Laughon et al. A summary plus appraisal. Let me know if you notice any errors or have other thoughts about this study.

Am not sure about the title of the talk, the objectives and the audience. But IMO the key high-level problems with BPD to be highlighted are 1. We are continuing to use a definition based on the treatment given, not on the disease pathology or pathophysiology. 2. The certainty of evidence for how we assess and manage BPD is low. There have been hardly any RCTs on evolving or established BPD. Yet, in the absence of high certainty evidence groups have formulated recommendations and guidelines based merely on expert opinion and low-level evidence. These guidelines have become established in practice, and have created a lack of equipoise for rigorous studies. Every NICU has its own set of beliefs and traditions on how to manage BPD. 3. We know very little about how to transition babies with BPD to the home (or institutional) setting and how to manage them after the transition. This includes care and support of the parents.

If you look back at all the research and experience in Neonatology over the past 30 years, what is the main message that emerges? IMO it is “Less is More”. We used to think that more intervention is better, and more aggressive, earlier interventions are better. Instead we have learned the opposite is true. #neotwitter