Opening lecture in Port said third neonatology conference, 18 & 19 October, 2012, by Osama Hussein

1. PORT SAID
THIRD
NEONATOLO
GY
CONFERENCE

2. EVIDENCE BASED
“I will prescribe regimens for the good of
my patients according to my ability and my
NEONATOLOGY
judgment and never do harm to anyone.”

3. In the past, doctors didn't always have access to the latest
medical research. They often used to decide how to treat
patients using only their own judgment and experience, and
what they learnt at medical school. We now know that this is
not the best way to practice medicine. This is because what
doctors think is best for a patient is not always what is best
when you actually look at the research.
When researchers study a disease or a condition, they look at
many more patients than a doctor will ever treat. Also,
medical knowledge changes all the time. And what doctors
used to think was the best thing to do, even a few years ago,
might actually be considered harmful today.
Only by looking at all the evidence and judging it fairly can
you work out what the research really says about a treatment.
This is called practicing evidence-based medicine

5. Randomized Controlled
Double Blind Studies
Randomized
Controlled Studies
Case Controlled Studies
Case Series
Case Studies
Ideas, Editorials, Opinions
Animal Research
In Vitro Research

6. Evidence-Based Medicine came to the fore in the
early 1990s and has become a major driving force
for many national healthcare organizations. The
term and concept originated at McMaster
University. It has been defined as "the integration
of best research evidence with clinical expertise
and patient values" (Sackett, 2000).

7. Best external
evidence
Individual Patient
clinical values &
expertise expectations

8. Fifty years ago, women were often given an enema
while they were in labour. This is uncomfortable and
unpleasant. But doctors thought that enemas would
reduce the risk of infection for the woman and her
baby. Some hospitals gave soapy enemas, which were
painful for women. When doctors studied the results
from the research, they found there was no evidence
that enemas prevented infections. Two studies showed
that enemas made more of a mess, and women felt
embarrassed by the enema. Women no longer have
enemas while they're in labour
Cuervo LG, Rodriguez MN, Delgado MB. Enemas during labor (Cochrane
review). In: The Cochrane Library, Issue 2, 2000. Update Software, Oxford, UK.

9. BMJ. 2008 Sep 9;337:a1490. doi: 10.1136/bmj.a1490.
Paracetamol plus ibuprofen for the treatment of fever in children : economic
evaluation of a randomized controlled trial.
Hollinghurst S, Redmond N, Costelloe C, Montgomery A, Fletcher M, Peters TJ,
Hay AD.
OBJECTIVE:
To estimate the cost to the NHS and to parents and carers of treating febrile
preschool children with paracetamol, ibuprofen, or both, and to compare
these costs with the benefits of each treatment regimen.
MAIN OUTCOME MEASURES:
Costs to the NHS and to parents and carers. Cost consequences analysis at 48
hours and 5 days comparing cost with children's temperature, discomfort,
activity, appetite, and sleep; cost effectiveness analysis at 48 hours comparing
cost with percentage of children "recovered.“
CONCLUSIONS:
There is no strong evidence of a difference in cost between the treatments, but
clinical and cost data together indicate that using both drugs together may be
most cost effective over the course of the illness. This treatment option
performs best and is no more expensive because of less use of healthcare
resources, resulting in lower costs to the NHS and to parents.

10. Thousands of premature babies died because
antipartum corticosteroids was not widely used. In
1972, the first of several studies was published showing
that giving corticosteroids to women about to have a
premature baby could protect the baby from
respiratory distress syndrome. But it was another 20
years before obstetricians began using these
corticosteroids regularly.
Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid
treatment for prevention of the respiratory distress syndrome in premature
infants. Pediatrics. 1972; 50: 515-525.

11. High flow nasal cannula for neonatal
respiratory disorders
There is growing evidence of the feasibility of HFNC as an
alternative to other forms of non-invasive ventilation in
preterm infants. However, there remains uncertainty about
the efficacy and safety of HFNC in this population. Until the
results of larger randomized trials are known, widespread use
of HFNC to treat preterm infants cannot be recommended.
(Manley, 2012)
Based on the results of this review there is insufficient
evidence to determine whether or not HFNC is safe or
effective as a form of respiratory support in preterm infants.
When used following extubation, HFNC may be associated
with a higher rate of reintubation than nasal CPAP. (Cochrane,
2012)

12. Animal-derived surfactants have been shown to be
superior to synthetic surfactant without proteins
(Chochrane, 2009). When bovine and porcine
derived surfactant preparations were compared,
data were favoring the porcine derived surfactant
in 5 randomized controlled trials and two
retrospective studies (Pediatrics, 2011). Yet in
some Islamic countries it is not desired to use
porcine derived surfactant.

13. The Cochrane Collaboration is a major force in the EBM
movement. It was created as a response to a call by
Archie Cochrane, a British epidemiologist, to develop
up-to-date systematic reviews of randomized controlled
trials from all areas of health care the best available
evidence could be made available as a basis for making
healthcare decisions. The first Cochrane Centre was
opened in Oxford in

15. Using amp & Gent combination
El Nasr NICU, Port said, Egypt
amp&gent total amp & others

16. nights/case
nights/case

17. mort/adm
mort/adm El Nasr NICU, Port said, Egypt

18. EVIDENCE BASED MEDICINE ADVANTAGES
• It offers the surest and most objective way to
determine and maintain consistently high quality
1 and safety standards in medical practice
• It can help speed up the process of transferring
clinical research findings into practice
2
• It has the potential to reduce health-care costs
significantly
3

20. I'm not a handsome guy, but i can give
my Hand-to-some guy who needs help