Abstract
The historical review of how evidence was developed for the management of respiratory
distress syndrome in premature infants has not been clearly characterized. Knowledge
of this process is essential to understand the role of equipoise and its influence
on the decision to evaluate interventions as they were implemented in the practice
of medicine. We suspect that errant approaches to clinical equipoise secondary to
states of false certainty and false uncertainty have been important barriers to the
timely acquisition and implementation of evidence-based knowledge necessary to improve
outcomes in this fragile population of infants. When confronted with the decision
to test an intervention, physicians should question whether they have lost clinical
equipoise based on opinion, expertise, or observational data rather than evidence
obtained from methodological inquiry; doing so facilitates reaching clinical equipoise
and promotes the application of scientific methodology to answer relevant clinical
questions. Timely acquisition of evidence-based knowledge can be viewed as an ethical
imperative when the status quo may have negative consequences on outcomes for generations.
Keywords
premature infant - respiratory distress syndrome - randomized controlled trials
