Neonatal surgery: towards evidence-based practice and management

Like all modern medical therapy, neonatal surgery is founded on clinical research, well-tried clinical practice and basic scientific research. Likewise, modern neonatal surgery strives increasingly for evidence-based management and practice. The very nature of neonatal and pediatric surgery renders associated research challenging because of the rarity and small numbers of surgical disorders and varying resources in different countries and institutions and consequently only a few well-designed trials on truly important issues in neonatal surgical treatment have been performed. This article highlights the research methods by which valid evidence-based research data is obtained in observational studies, randomized controlled trials, and meta-analyses. The problem of small numbers of patients may be overcome by multi-center trials, meta-analyses, and networking. Consideration is also given on the quality and the validity of the study data as well as ethical issues in neonatal surgical research.