Quality of the studies
The prophylactic surgery study had very high mortality, approximately 60% in both study groups, reflective of outcomes in the presurfactant era. Also, the 30% incidence of NEC in the control group was higher than reported in current populations.
The other presurfactant era study reported a higher incidence of NEC in the primary surgery group. The surgical infants were smaller in weight, but other baseline characteristics were not described; therefore, it is possible that these were sicker infants who were selected for surgery. In the studies that did not demonstrate a statistically significant difference in the outcome of NEC, the major confounders identified were that the primary surgery group of infants tended to have lower BW and younger GA, as well as having higher incidence of pretreatment IVH, which was the most common contraindication to treatment with indomethacin. These confounders were not controlled for in the study analyses, likely due to the small sample size in most of the studies. Hemodynamic significance of the PDA as assessed by echocardiogram was not quantified or adjusted for in any of the studies. Looking for a great online pharmacy you could trust and where you could find best birth control drugs at best prices? You have one pharmacy like that already and can finally enjoy the best quality of service ever experienced.