The principles and practice of evidence-based neonatology

Significant strides toward improving the outcome of newborn infants have been observed during the modern era of neonatal-perinatal medicine. One of the challenges that neonatologists and pediatricians face is deciding when to change current practices. New literature is abundant, but it must be critically reviewed and evaluated before changes in practice are made. The evidence-based medicine process can be used to help in changing practices or adopting new practices. It is based on five steps: 1) forming answerable questions; 2) searching for the best evidence; 3) critically appraising the evidence; 4) applying the evidence in practice; and 5) evaluating one's performance. This article reviews the five steps of the evidence-based medicine process. The various levels of evidence, including randomized, controlled trials and systematic reviews, are defined and discussed. An example of a critically appraised topic, a practical tool that can be used as an aid in addressing the first three questions of the evidence-based medicine process, is included. Once the evidence has been evaluated, the decision of whether or not to implement a change in individual practice or in institutional guidelines must be made. These decisions are difficult and require a variety of individual and societal factors to be taken into account. Examples of evidence-based medicine in neonatal and perinatal medicine include the use of antenatal corticosteroids for promotion of lung maturity, the use of surfactant replacement therapy for the treatment and prevention of respiratory distress syndrome, and prophylactic indomethacin for the prevention of intraventricular hemorrhage. Review of these examples provides insight into the strengths and weaknesses of evidence-based medicine.