1. Routine data and opportunities to improve patient outcomes Iain Chalmers Coordinator, James Lind Initiative National Institute of Health Research National Neonatal Audit Programme and Neonatal Data Analysis Unit Collaborators’ Meeting 20 January 2012

4. For example, how can the risk of cerebral palsy be reduced in children born prematurely?

5. What are the effects of caffeine for apnoea of prematurity?

6. Authors' conclusions Five controlled trials studying a total of 192 preterm infants with apnea show that caffeine therapy reduces apnea and artificial ventilation over the first 2- 7 days after birth. The effects of caffeine on longer-term outcomes is being studied in a large ongoing study.

7. Long-Term Effects of Caffeine Therapy for Apnea of Prematurity Barbara Schmidt, M.D., Robin S. Roberts, M.Sc., Peter Davis, M.D., Lex W. Doyle, M.D., Keith J. Barrington, M.D., Arne Ohlsson, M.D., Alfonso Solimano, M.D., Win Tin, M.D., for the Caffeine for Apnea of Prematurity Trial Group Conclusions Caffeine therapy for apnea of prematurity improves the rate of survival without neurodevelopmental disability at 18 to 21 months in infants with very low birth weight Volume 357:1893-1902 November 8, 2007 Number 19November 8, 2007

8. What are the effects of giving antibiotics to try to stop premature labour?

9. This review fails to demonstrate a clear overall benefit from prophylactic antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased neonatal mortality for those who received antibiotics… The 17 citations awaiting classification may alter the conclusions of the review once assessed.

12. Because uncertainties about the long term effects of prescribing caffeine for apnoea of prematurity and antibiotics in spontaneous preterm labour were not investigated 25 years ago, tens of thousands of people are now living with cerebral palsy that might have been prevented.

13. Why weren ’ t these studies done quarter of a century ago?

14. We need to confront important uncertainties about the effects of treatment because otherwise: ● patients will be denied unrecognised beneficial care ● patients will be given unrecognised harmful care ● resources will be wasted on useless or unnecessarily expensive care And ‘ we ’ means all of us!

16. New opportunities Using electronic patient records to run simple randomised evaluations as integral elements of normal health care

17. The General Practice Research Database Randomised Evaluations of Accepted Choices in Treatment (REACT studies)

18. How about using a similar approach to address treatment uncertainties in neonatal care?