Evidence-based neonatology: making a difference beyond discharge from the neonatal nursery.

The number of controlled clinical trials in neonatal medicine has increased steadily over recent years. However, most of these trials examine only short-term outcomes during the initial hospital stay. To determine whether a common neonatal intervention does more good than harm, it is important to study its long-term efficacy and safety. This review summarizes randomized trials of neonatal therapies published between October 2000 and September 2001. Only trials that examine outcomes beyond the initial hospital discharge were considered. Four beneficial interventions were identified: promotion of breast-feeding, comprehensive follow-up care for high-risk, very low birthweight infants, cryotherapy for threshold retinopathy of prematurity, and extracorporeal membrane oxygenation for mature infants with severe respiratory failure. Indomethacin prophylaxis in extremely low birthweight infants is of questionable use. Thyroxine supplementation for premature infants and head cooling for asphyxiated term infants require further study and should not be prescribed outside of rigorous clinical trials.