Article type
Year
Abstract
Introduction: Systematic reviews in pregnancy and childbirth have been available for many years. In the 80's from the Oxford Database of Perinatal trials, in the 90's from Effective Care in Pregnancy and Childbirth, Effective Care of Newborn Infant and the Cochrane Library (CL). An Australian survey suggested that 72% of Neonatologists reported using systematic reviews. However, it is unclear whether this has changed practice or lead to more research. High Frequency Oscillatory ventilation (HFOV) was one of the first reviews in Neonatology to be published in the CL (1996). The results of the review were also presented at appropriate professional meetings.
Objectives: The main objective of this study was to review the published systematic reviews on HFOV in preterm infants and then to compare the use of HFOV by Neonatologists in NSW, Australia prior to and after the publication of the reviews in the Cochrane library.
Methods: Systematic reviews from the CL were reviewed regarding the recommendation about the use of HFOV in preterm infants. Use of HFOV in the units in NSW were collected from the NSW Intensive Care data collection.
Results: Two reviews of HFOV in preterm infants were found in the library. The recommendations were split into recommendations for practice and recommendations for research. The recommendations for practice suggested that when HFOV was used in the rescue mode there was no evidence to recommend its use; the small amount of data suggests more harm than benefit. Routine use of elective of HFOV in preterm infants could not be recommended unless issues regarding harms and benefits at different gestations and long term neurodevelopmental outcomes were resolved, since there was a trend towards increase in risk of intraventricular haemorrhages in some studies. The recommendations were that any future use should be within randomised controlled trials. Despite the above evidence the use of HFOV by Neonatologists in NSW has increased by 97% since 1995.
Discussion: Despite the lack of strong evidence of the benefits of HFOV in preterm infants and wide dissemination and availability of the evidence and increased use of the Cochrane library by the Australian Neonatologists there is increasing use of HFOV in NSW. Novel strategies, beyond provision of the evidence, are required to get evidence into practice in Neonatology in order to achieve better outcomes for patients.
Objectives: The main objective of this study was to review the published systematic reviews on HFOV in preterm infants and then to compare the use of HFOV by Neonatologists in NSW, Australia prior to and after the publication of the reviews in the Cochrane library.
Methods: Systematic reviews from the CL were reviewed regarding the recommendation about the use of HFOV in preterm infants. Use of HFOV in the units in NSW were collected from the NSW Intensive Care data collection.
Results: Two reviews of HFOV in preterm infants were found in the library. The recommendations were split into recommendations for practice and recommendations for research. The recommendations for practice suggested that when HFOV was used in the rescue mode there was no evidence to recommend its use; the small amount of data suggests more harm than benefit. Routine use of elective of HFOV in preterm infants could not be recommended unless issues regarding harms and benefits at different gestations and long term neurodevelopmental outcomes were resolved, since there was a trend towards increase in risk of intraventricular haemorrhages in some studies. The recommendations were that any future use should be within randomised controlled trials. Despite the above evidence the use of HFOV by Neonatologists in NSW has increased by 97% since 1995.
Discussion: Despite the lack of strong evidence of the benefits of HFOV in preterm infants and wide dissemination and availability of the evidence and increased use of the Cochrane library by the Australian Neonatologists there is increasing use of HFOV in NSW. Novel strategies, beyond provision of the evidence, are required to get evidence into practice in Neonatology in order to achieve better outcomes for patients.