The ongoing quandary of defining the standard of care for neonates

Abstract

Despite extensive use of the term 'standard of care' (SOC), there is no such medical definition. How are neonatal therapies accepted as SOC with huge centre-to-centre variation? What defines SOC? We will consider paths to acceptance of multiple therapies (antenatal corticosteroids, preventing GBS, others). We conclude single-centre trials drive care, but are not consistently predictive for multicentre trials. Innovation/quality improvement initiatives also alter care, despite strong evidence practice changes take time. Furthermore, there are powerful medico-legal implications if a therapy is designated SOC.

Conclusion: Defining SOC is a quandary with more legal implications than medical, but what's most critical is keeping current in a rapidly changing field.

Keywords: Expert testimony; Malpractice; Neonatology; Quality improvement; Standard of care.