Tag Archives: Randomized Controlled Trials

The list of shame, and the continued shame of the Journal “Pain”

Posted on 9 June 2022 by Keith Barrington

Randomized controlled trials of pain control measures prior to planned painful procedures that have an untreated control group are unethical. I would have thought in 2022 that statement was about as uncontroversial as a statement about ethics could be, nevertheless … Continue reading →

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Preventing desaturation during intubation. Shine on, you crazy….

Posted on 26 May 2022 by Keith Barrington

Recommendations for older children and adults during endotracheal intubation frequently include the use of free flow oxygen, indeed when I was a fellow with Neil Finer we routinely provided additional free flow oxygen from a catheter placed near the nose, … Continue reading →

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Automated oxygen control, what’s taking so long?

Posted on 29 April 2022 by Keith Barrington

A long long time ago, in a galaxy… actually quite near here, the idea of servo control of inspired oxygen was already in the air. At the time I first heard about it, the idea was to control FiO2 based … Continue reading →

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Antenatal steroids prior to late preterm delivery; still many questions, but a major shift in practice.

Posted on 7 April 2022 by Keith Barrington

It can sometimes take years for major advances in medicine, based on clear evidence of improved outcomes, to lead to shifts in practice. One example is the initial demonstration by Liggins and Howie that antenatal steroids (ANS) improved survival of … Continue reading →

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Steroids to improve pulmonary outcomes in preterm infants.

Posted on 29 March 2022 by Keith Barrington

When we consider using steroids in a preterm infant, ventilator dependent, with evolving lung disease, what outcomes are we most interested in? Survival, surely, is the first outcome that we want to improve, and secondly long-term pulmonary health. The adverse … Continue reading →

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Hydrocortisone, with backup dexamethasone, to prevent Bronchopulmonary Dysplasia

Posted on 28 March 2022 by Keith Barrington

A trial that has been awaited for a while has just been published (Watterberg KL, et al. Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia. N Engl J Med. 2022;386(12):1121-31). It was a multi-centre RCT of hydrocortisone in 800 very preterm … Continue reading →

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Common interventions for common conditions; what do they have in common? A lack of evidence.

Posted on 21 March 2022 by Keith Barrington

There are a number of problems in neonatal care for which good evidence is lacking, and an evidence based approach is therefore not really possible. Two recent reviews highlight this problem. The first is a systematic review of tactile stimulation … Continue reading →

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Composite outcomes for research; this is how to do it!

Posted on 21 March 2022 by Keith Barrington

As regular readers of the blog will know, I have been very critical of some very important, otherwise excellent, trials over one vital part of their design, that is, the use of composite outcomes such as “death or BPD”, “death … Continue reading →

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Should we give up on nebulised surfactant?

Posted on 17 March 2022 by Keith Barrington

A new RCT of curosurf given by nebulisation was published shortly after a systematic review of the previous data. The RCT showed no real benefit, whereas the SR suggested efficacy. The RCT first, this international trial (Dani C, et al. … Continue reading →

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Should we feed insulin to preterm babies?

Posted on 8 March 2022 by Keith Barrington

This was an idea I had not heard about prior to seeing this newly published trial (Mank E, et al. Efficacy and Safety of Enteral Recombinant Human Insulin in Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2022). The introduction … Continue reading →

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