Should very prem babies be given CPR?
2 Aug, 09 | by Bob Phillips
A premature baby born at 24 weeks gestational age is admitted to the neonatal unit having been born in poor condition and receiving cardio-pulmonary resuscitation (CPR) with adrenaline in the delivery room. Considering the available evidence, is the use of CPR at delivery of extremely premature infants associated with very poor outcomes such that CPR in these infants may be inappropriate? Does the administration of CPR provide these infants with a chance of survival free of disability?
Sometimes we are in situations where we think that something causes problems, and we can’t do a trial randomising one group to get something which we think causes problems! How do we then go about finding out - how to we avoid the problems of ‘confounding’ - and what is that anyway? For example, think about necrotising enterocolitis. Which babies develop NEC? 
What do you do if, accidentally, you scan the abdomen of a neonate and find nephrocalcinosis? Book them in for a transplant in a couple of years? Annual serum electrolytes, blood pressure & isotopic GFR measurement? Pretend you hadn’t seen it?
Does extra-corporeal membrane oxygenation improve survival for severely unwell neonates with Congenital Diaphragmatic Hernia?
Length of stay for ‘well’ near term (30-36 week gestation) babies varies between units and between countries, with the UK average being discharge at 36+2 weeks corrected. What strategies are in place in your unit to help these ’small but well’ babies get out of precious neonatal cots into their own lovingly decorated cribs at home? And more to the Archimedes point - is there any evidence these interventions work?