Systematic Reviews: Clinical Scenario
You are asked to provide antenatal counselling to a mother with imminent premature delivery at 26 weeks gestation. Both parents are concerned about the prognosis of their baby. They have read on the Internet that early indomethacin may improve their child's neonatal course. You are aware of the cautious recommendation by Nehgme et al, based on their systematic review, to use indomethacin prophylaxis in infants with birth weights < 1500 grams (Nehgme RA, O'Connor TZ, Lister G, Bracken MB. Patent ductus arteriosus. In:Sinclair JC, Bracken MB, editors. Effective care of the newborn infant. Oxford: Oxford University Press; 1992. P. 281-324). However, you have remained concerned about the long-term efficacy and safety of this approach and wonder whether more information has since become available.
You formulate the question, "In a very premature infant, does indomethacin prophylaxis improve survival without severe disability?"
You have a bookmark for the NIH Web Site that publishes all neonatal reviews for the Cochrane Collaboration: silk.nih.gov/silk/cochrane (no longer online). You click on "Collection of Documents and Reviews", then click on "Proceed to Systematic Reviews". On "The Cochrane Neonatal Collaborative Review Group" page, you click on "Search this site" and enter the word "indomethacin". Of the four reviews, one is a perfect match. After reading the abstract, you decide to print the whole document off the web site http://silk.nih.gov/silk/cochrane/fowlie/fowlie.htm (no longer online)
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?