How is Neonatal Care Growing Up?
Pediatrics – the care of infants, children and adolescents – and neonatology – the care of newborns for the first 28 days after birth – are relatively new medical specialties; they’re still in their infancy, if you'll forgive the pun.
For instance, in the US, the National Association of Neonatal Nurses (NANN) – the professional organization for neonatal nurses – only celebrated its 30th anniversary in June 2014; it was founded in 1984 by five neonatal nurses: Patricia Johnson, Linda Bellig, Tracy Karp, Charles Rait and Donna Lee Loper. Within a year, the association boasted a membership of 3,790 and now has more than 7,000 members.
Both fields have come on in leaps and bounds over the past ten years. Specialist neonatal intensive care units (NICUs) concentrate on treating very small, premature, or congenitally ill babies and have greatly increased the survival of very low birth-weight and extremely premature infants. Before NICUs, infants with a birth weight of less than 1.4kg grams (3 lbs) – usually at about 30 weeks’ gestation – rarely survived. Today, experts are more confident that infants of 500 grams at 26 weeks may pull through. Because of significant medical advances and the efforts of physicians and nurses who provide for very vulnerable babies, survival rates are ten times better now than they were 15 years ago.
Key developments down the years have included the invention of the incubator (see below), changes in respiratory care and the development of surfactants. In 1980, the first study of the use of surfactants on infants took place in Japan and surfactant therapy has since improved the infant mortality rate by some 50%.
One major issue for medical science is the onset of premature labor. Each year, some 40,000 low-birth-weight infants are born in the United States. Preventing premature labour remains a pressing but perplexing problem for doctors. This is because, even though medical advances help doctors to save low-birth-weight babies, it is almost invariably better to delay such births.
What are the most common problems that neonatal carers encounter? Clinicians tend to work with infants who have birth defects, infections, cardiac malformations, and surgical problems. Although the neonatal period is defined as the first month of life, many infants are often sick for months and a few neonatal nurses may care for infants up to about two years of age. Most care for infants from the time of birth until they are discharged from the hospital.
History of infant care
Ancient medics and scientists such as Hippocrates, Aristotle and Galen, understood that the differences between growing and maturing organisms necessitated different treatment. Some of the earliest origins of pediatrics can be traced to ancient India where children’s doctors were known as kumara bhrtya. A second century AD manuscript by the Greek physician and gynaecologist Soranus of Ephesus discusses neonatal pediatrics.
In the mid-nineteenth century, the infant incubator was first developed, based on designs used to hatch chicken eggs, by Dr Stephane Tarnier. His researches were followed by those of fellow Frenchman Dr. Pierre Budin, who noted the limitations of raising infants in incubators and the importance of breast milk and the mother’s attachment to the child. Dr Budin is known as the father of modern perinatology, and his seminal work The Nursling (Le Nourisson in French) became the first major publication to deal with the care of the neonate.
The first generally accepted pediatric hospital is the Hôpital des Enfants Malades, which opened in Paris in June 1802 on the site of a previous orphanage. From its inception, this famous hospital accepted patients up to 15 years of age and continues today as the pediatric division of the Necker-Enfants Malades Hospital, which was created in 1920 by merging with the next-door Necker Hospital, founded in 1778.
Pediatrics as a medical specialty was developed in the mid-19th century by the German Abraham Jacobi (1830–1919), who later practiced in New York City. In contrast, neonatal care only became a specialty in the United States in 1960 when the first American newborn intensive care unit, designed by Louis Gluck, was opened in October that year at Yale-New Haven Hospital, Connecticut.
How will Neonatal care progress in the future?
Continuing research, into premature labor and the care of pre-term babies, will be able to detect better and faster ways of diagnosing and treating specific conditions. The range of equipment will, no doubt, be far superior to the already excellent NICU environment we have today. But education will remain a key factor in delivering & nurturing these babies. To this end, we will always provide a range of hands-on scientific education created for the medical professional. What are your experiences of learning about Neonatal care?