• Resuscitation
• Neonatology

In their quest to optimise treatment strategies, neonatologists may sometimes be tempted to extrapolate results obtained during the care of very immature to more mature neonates, assuming that what is right in the former, most fragile infants cannot be wrong in the latter. A study from Tokyo, however, highlights the potential risks associated with such generalisations: in an audit of neonatal care, Hishikawa et al1 noted that, following the adoption of new guidelines issued by the Japanese resuscitation council, the proportion of term neonates receiving continuous positive airway pressure (CPAP) via face mask increased from 1.7% to 11.1%. This shift in clinical practice was associated with a doubling of the rate of infants with a diagnosis of pulmonary air leak (from 1.0% to 1.8%). Part of this increase may have been due to an increase in the number of infants receiving chest X-rays (8% before vs 17% after the new guideline), that is, a diagnostic shift, but this is unlikely as the latter rise was not disproportionate to the increase in air leaks.1

Faced with these data from a retrospective audit, is it plausible that the observed association is true, that is, may there indeed be a relationship between …