Neonatology Specialty Grand Challenge

John Steven Torday

doi:10.3389/fped.2013.00013

Abstract

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Neonatology Specialty Grand Challenge

Highlights

Such breakthroughs as Helen Taussig’s surgical approach to the treatment of the Tetralogy of Fallot (4); the Liley Score for hyperbilirubinemia (5); the L/S ratio (6), Continuous Positive Airway Pressure ventilation (7), antenatal steroids (8), and postnatal exogenous surfactant to prevent and treat Respiratory Distress Syndrome (RDS) (9) all led inexorably to the fetus as a patient
The first American textbook on prematurity was published in 1922 (2). It was not until 1965 that the first American newborn intensive care unit (NICU) was opened at Yale University, but more importantly, only a few years later Egon Diczfalusy conceptualized the fetoplacental unit (3), which established that the fetus actively participates in its own physiologic development in utero
This represented a fundamental break with Victorian attitudes toward maternal confinement during pregnancy, and set the bar for reproductive physiology to this day. It was the advent of antenatal steroids for lung immaturity that was the call to action for the Neonatology Community – the realization that there was a way to proactively affect the outcome of preterm birth, not merely passive watchful waiting (For example, Dr Gluck’s dictum that if the L/S ratio were less than 2:1, to wait for 2 weeks and retest)

Summary

Introduction

Such breakthroughs as Helen Taussig’s surgical approach to the treatment of the Tetralogy of Fallot (4); the Liley Score for hyperbilirubinemia (5); the L/S ratio (6), Continuous Positive Airway Pressure ventilation (7), antenatal steroids (8), and postnatal exogenous surfactant to prevent and treat Respiratory Distress Syndrome (RDS) (9) all led inexorably to the fetus as a patient. Though high infant mortality rates were recognized by the British medical community at least as early as the 1860s, the advent of neonatal intensive care is relatively recent.

Results

Conclusion