Knowledge

I just got back from the Pediatric Academic Societies meeting in San Francisco. It was a nice conference, with a good mix of both original research and review presentations. As a younger doc I used to come home from these conferences fired up about all the new and exciting things. Lately, though, I come home from them reminded more about how much we don't know rather than what we do know.

There's some pretty basic stuff we don't know. We don't know, for instance, when to transfuse babies with blood. We don't know whether giving sodium bicarbonate, a relatively common drug, does any good or not. (Well, actually we're pretty sure it doesn't do much good, but we use it anyway.) We don't know how to measure pain very well in premature babies or the best way to treat it. And if and when we do treat it, we don't know if that improves their overall outcome or not. We don't know the best way to treat low blood pressure in premies. We're not sure what the medicines used to treat low blood pressure do to the brain. For that matter, we don't really know what constitutes low blood pressure in the tiny premies, and like pain treatment, we don't know if treating it makes a difference in their long term outcome. I could go on and on about the stuff we don't know.

Sure, we often act like we know. (Parents don't like it if we don't.) For example, I could tell you at what point I treat low blood pressure in a small baby, and how I would treat it, but I'd be kidding both of us if I said I knew it made a difference for the better. Some neonatologists will tell you they do know when to treat low blood pressure and that they know it helps. Physicians with such bravado are probably the scariest docs of all, at least to me.

Don't be too discouraged by this. We've made some tremendous strides in improving the care of neonates. But for every question we've answered, it seems there are a dozen more still to be answered.

P.S. Grand Rounds is up at Polite Dissent.