In the bestselling book, The Checklist Manifesto, Atul Gawande laments about the current state of health care in which avoidable failures abound. “We train longer, specialize more, use ever-advancing technologies, and still we fail.” Part of the problem, he argues, is that the ever-increasing complexity of medicine makes uniform care delivery impractical or impossible. That is, unless there are guidelines, checklists, or care paths that are readily available to providers.
Standard textbooks, journals, and online resources currently available create excellent repositories of detailed information about the etiology, pathogenesis, clinical picture, diagnosis, and treatment of a condition. However, for a busy clinician looking for the best way to manage a sick patient, a standardized path for effective management of the patient may be impossible to discern. Admittedly, evidence-based practices are simply not available for many maladies, yet for many others, there are conflicting ones. Still, wouldn’t it be a lot easier if we all managed simple things in a uniform way using the best available evidence, and tracked easily collated data to make changes? Pediatric oncology groups have done this better than anyone else, and in so doing have transformed their field. Why do we have to wait decades before best practices are made available to every patient?
In neonatology, busy clinicians have all felt the need for a concise, easy-to-use resource at the bedside for evidence-based guidelines, or consensus-driven care paths where high-grade evidence is not available. This book attempts to fill that void and is the product of contributions from numerous authors from all over the world, and the section editors who oversaw the work of individual authors. The book is divided into 11 discrete sections with the chapters in each section having a format different from that of textbooks and manuals. In addition to major recommendations and practice options, chapters also contain suggested quality metrics and descriptions of implementation strategies for the clinical practices. We hope that such an approach will encourage clinicians to apply available evidence to their practice and also track compliance with desired practices. A wide variety of common neonatal problems are addressed in this book. Our goal was not to create an encyclopedic work that included all neonatal topics—we thought that role was best left to the standard, large textbooks of neonatology, of which there are many. We hope that practicing neonatologists, fellows, nurse practitioners, and other NICU personnel will find this book useful in delivering high-quality clinical care to their patients and their families. We remain open to feedback and suggestions about how to improve this resource and how to make it maximally useful to those delivering care at the bedside in the NICU.
Lucky Jain, MD
Gautham K. Suresh, MD