Is there a strategy for preventing bronchopulmonary dysplasia? Absence of evidence is not evidence of absence

Bronchopulmonary dysplasia (BPD) is a serious health problem associated with mortality and high morbidity among graduates of the NICU.1 The cost of BPD is tremendous. It is associated with prolonged hospitalization of the preterm infant, multiple rehospitalizations during the first few years of life, and survival with developmental delay and/or cerebral palsy.1,2 It becomes, therefore, a major goal for the neonatal community to prevent or at least partially control the incidence of BPD. In an effort to scientifically ameliorate the incidence of BPD, Walsh et al3 examined the 3 best-performing NICUs among the 17 units of the National Institute of Child Health and Human Development Neonatal Network. The study team determined some practices in these 3 units that they could adopt in a clinical trial. They then initiated a cluster-randomized, controlled trial among the remaining 14 units; 7 of these units changed their practices accordingly, and the other 7 units continued their routine care. Early administration of surfactant, use of vitamin A, and maintaining lower oxygen saturation were among the adopted practices in this randomized trial. Early nasal continuous positive airway pressure (CPAP) was not one of the targeted practices to change, because there was "insufficient evidence" to support its use. In fact, when compared with the control group, the 7 NICUs in the intervention group used more endotracheal intubation (77% vs 66%) and less CPAP (16% vs 27%) in the delivery room. During the first week of life, mechanical ventilation was more prolonged in . . . [Full Text of this Article