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JOURNAL CLUB
Landmark Neonatal Trials
The trials worth knowing, grouped by system - the studies that shaped how we care for newborns.
Antenatal corticosteroids (Liggins & Howie)
First showed antenatal steroids reduce RDS and neonatal death in preterm infants.
NINOS
Inhaled nitric oxide reduced death or ECMO in term infants with hypoxic respiratory failure.
CAP - Caffeine for Apnea of Prematurity
Caffeine reduced BPD and improved survival without neurodevelopmental disability.
COIN
Nasal CPAP from birth reduced ventilation compared with intubation in very preterm infants.
SUPPORT
Early CPAP vs surfactant, and lower vs higher oxygen saturation targets, in extremely preterm infants.
NEODRY
No thermoregulation benefit from drying before plastic wrapping in very preterm infants.
CoolCap
Selective head cooling for neonatal encephalopathy.
NICHD Whole-Body Hypothermia
Whole-body cooling reduced death or disability in term/near-term HIE.
TOBY
Whole-body cooling improved neurological outcomes in survivors of HIE.
HELIX
Cooling did not reduce - and may have increased - death/disability in low- and middle-income settings.
Preterm cooling (Faix)
No benefit, and a possible harm signal, from cooling 33-35 week infants with HIE.
TIPP - Indomethacin prophylaxis
Prophylactic indomethacin reduced severe IVH and PDA, but not survival free of neurosensory impairment.
BeNeDuctus
Expectant management was non-inferior to early treatment for PDA in preterm infants.
ProPrems
Probiotics reduced necrotising enterocolitis in very preterm infants (Australian trial).
ELFIN
Lactoferrin supplementation did not reduce late-onset sepsis in very preterm infants.
SIFT
Faster vs slower enteral feed advancement made no difference to survival without disability.
APTS - Australian Placental Transfusion Study
Delayed cord clamping reduced death and major morbidity in very preterm infants.
ETTNO
Liberal vs restrictive transfusion thresholds made no difference to death or neurodevelopment.
TOP - Transfusion of Prematures
Higher vs lower haemoglobin transfusion thresholds made no difference to outcomes at 2 years.
A starting collection. These are landmark trials grouped by system to build on over time. Confirm the exact citations against the original papers before relying on them, and tell me which to add - I can build a full one-page appraisal for any of them.
For educational purposes only. Always align management to current ANZCOR/NRP guidelines and your local SCN/NICU or NETS protocols.