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Landmark Neonatal Trials
The trials worth knowing, grouped by system - the studies that shaped newborn care. This is background and exam-level reading, not day-one essentials; some involve very preterm babies a special care nursery stabilises and retrieves rather than manages.
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.
Resair 2 (Saugstad)
Room air was at least as effective as 100% oxygen for resuscitating asphyxiated newborns - the basis for lower-oxygen resuscitation.
Vigorous meconium (Wiswell)
Routine intubation and tracheal suctioning of vigorous meconium-stained infants did not reduce meconium aspiration - the end of routine suctioning.
Occlusive wrap (Reilly)
Polyethylene occlusive wrap reduced hypothermia in extremely preterm infants but did not reduce mortality.
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.
Cord milking vs DCC (PREMOD2)
Umbilical cord milking was linked to more severe IVH than delayed cord clamping in very preterm infants - the trial was stopped early.
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.
For educational purposes only. Always align management to current ANZCOR/NRP guidelines and your local SCN/NICU or NETS protocols.