#473 - 🟣 [FANNP 2026] - High yield articles from the last year!

But the first article we're going to cover was the NICHD, like the NRN PDA expectant management RCT that was published this year.

Basically looking at whether or not expectant management, and this is just a subset of babies.

So it's our 22 weeks to 28 week babies.

who were deemed to have a clinically significant PDA.

So there were set criteria in the trial.

But essentially, this is a group that we all deal with in our NICUs.

And it's a question that has come up.

I've been doing this for 25 years.

I don't know that we've had the answer for what to do with the PDA.

And if you ask 10 people, you might get 10 different answers.

So this... randomized trial really sought to try and answer that question, at least for this subset of babies, for these subset of high-risk babies.

And what was very interesting about this trial is they had to halt it early.

So they were supposed to recruit 800 babies, I think, for it to be powered enough to answer their primary outcome, which was death or BPD at 36 weeks.

Yet they had to halt it, I think, at about 480 patients that were recruited because of a safety concern.

They were starting to see trends where the mortality in the treatment group was higher, I mean, to the tune of like more than double.

And yet, as far as the primary outcome of death or BPD, they were really seeing no difference.

And so there was only about a 2% chance that if they finished the trial, recruited all 800 patients, there's only about a 2% chance that they would have actually found a difference there.

So But what really kind of got my attention was more the safety concern because our mantra when we start practicing medicine is first do no harm.

So if you're telling me something I'm doing routinely is potentially causing harm, you really have to put the brakes on and say, okay, we need to reevaluate our process.

We need to reevaluate what we're doing.

What was also interesting about that study is there were thousands of babies that were eligible but weren't randomized.

And when they looked at those babies, about 66% of them received treatment.

So that tells us that by and large, what we are doing in our hospitals nowadays across the country is treating PDAs in these very small, fragile infants.

And this study points out, the trial did conclude that there is a significant mortality risk for those babies.

especially if you're treating the mild babies.

But the first article we're going to cover was the NICHD, like the NRN PDA expectant management RCT that was published this year.

Basically looking at whether or not expectant management, and this is just a subset of babies.

So it's our 22 weeks to 28 week babies.

who were deemed to have a clinically significant PDA.

So there were set criteria in the trial.

But essentially, this is a group that we all deal with in our NICUs.

And it's a question that has come up.

I've been doing this for 25 years.

I don't know that we've had the answer for what to do with the PDA.

And if you ask 10 people, you might get 10 different answers.

So this... randomized trial really sought to try and answer that question, at least for this subset of babies, for these subset of high-risk babies.

And what was very interesting about this trial is they had to halt it early.

So they were supposed to recruit 800 babies, I think, for it to be powered enough to answer their primary outcome, which was death or BPD at 36 weeks.

Yet they had to halt it, I think, at about 480 patients that were recruited because of a safety concern.

They were starting to see trends where the mortality in the treatment group was higher, I mean, to the tune of like more than double.

And yet, as far as the primary outcome of death or BPD, they were really seeing no difference.

And so there was only about a 2% chance that if they finished the trial, recruited all 800 patients, there's only about a 2% chance that they would have actually found a difference there.

So But what really kind of got my attention was more the safety concern because our mantra when we start practicing medicine is first do no harm.

So if you're telling me something I'm doing routinely is potentially causing harm, you really have to put the brakes on and say, okay, we need to reevaluate our process.

We need to reevaluate what we're doing.

What was also interesting about that study is there were thousands of babies that were eligible but weren't randomized.

And when they looked at those babies, about 66% of them received treatment.

So that tells us that by and large, what we are doing in our hospitals nowadays across the country is treating PDAs in these very small, fragile infants.

And this study points out, the trial did conclude that there is a significant mortality risk for those babies.

especially if you're treating the mild babies.