Symposium on Synthetic Surfactant II: Perspective and commentary ☆ ☆☆ ★ ★★

The introduction of surfactant replacement 5 years ago has proved to be an important milestone in pediatrics in a number of ways. First, the clinical trials of surfactant have set a new standard for the clinical testing of potential innovations in the health care of children. No longer will champions of new "breakthroughs" for sick children delude themselves and others with the results from small, brief clinical trials conducted at a center or two. It is now clear that large multicenter trials with sufficient statistical power to answer the questions posed must be conducted. In addition, follow-up studies over periods long enough to know what really happened to the children who participated in the trials must be completed if we are to know whether the posited "breakthrough" is both safe and effective. After surfactant we pediatricians will be far less likely to do unwitting harm to the children we would like to help by adopting new therapies and techniques on insufficient evidence. To do no harm must remain our fundamental commitment. Large randomized trials are the only safeguard against getting lost in (1) enthusiasm for what is new and (2) desperation to do something. Therapeutic misadventure will continue to tarnish the checkered history of pediatrics unless we all moor to the safe bulwark of randomized clinical trials. This fundamental insight is perhaps the greatest legacy of the advent of surfactant replacement.