In 1960, the terms “neonatology” and “neonatologist” were introduced. Thereafter, an increasing number of pediatricians devoted themselves to full-time neonatology. In 1975, the first examination of the Sub-Board of Neonatal-Perinatal Medicine of the American Board of Pediatrics and the first meeting of the Perinatal Section of the American Academy of Pediatrics were held. One of the most important factors that improved the care of the neonate was the miniaturization of blood samples needed to determine blood gases, serum electrolytes, glucose, calcium, bilirubin, and other biochemical measurements. Another factor was the ability to provide nutrition intravenously, and the third was the maintenance of normal body temperature. The management of respiratory distress syndrome improved with i.v. glucose and correction of metabolic acidosis, followed by assisted ventilation, continuous positive airway pressure, antenatal corticosteroid administration, and the introduction of exogenous surfactant. Pharmacologic manipulation of the ductus arteriosus, support of blood pressure, echocardiography, and changes in the management of persistent pulmonary hypertension, including the use of nitric oxide and extracorporeal membrane oxygenation, all have influenced the cardiopulmonary management of the neonate. Regionalization of neonatal care; changes in parent–infant interaction; and technological changes such as phototherapy, oxygen saturation monitors, and brain imaging techniques are among the important advances reviewed in this report. Most remarkable, a 1-kg infant who was born in 1960 had a mortality risk of 95% but had a 95% probability of survival by 2000. However, errors in neonatology are acknowledged, and potential directions for the future are explored.

/pdf/the-evolution-of-neonatology-4izun53ion.pdf

The Evolution of Neonatology

Noninvasive measurement of cerebral bioimpedance for detection of cerebral edema in the neonatal piglet.

Neonatal intensive care units may choose to selectively withdraw support in some neonates with severe brain damage. We offer suggestions for criteria for such withdrawal, and a review of 20 cases in which such a decision-making process occurred in our neonatal intensive care unit.

Decisions to Withdraw Life Support in the Neonatal Intensive Care Unit

We report studies in which the amplitude of the cardiac-synchronous change in transcephalic impedance, delta Z, has been used in the investigation of cerebral haemodynamics in newborn babies. Three clinical situations, in which cerebral blood flow might be expected to change, have been studied. The impedance signal, delta Z, decreased in size during a tension pneumothorax, increased slightly with feeding, and, during an exchange transfusion of an asphyxiated baby, there was a consistent increase in the size of the signal during infusion of blood and a decrease in size as blood was withdrawn. This method may be useful for the continuous study of cerebral haemodynamics in the preterm baby over prolonged periods.

CEREBRAL HAEMODYNAMICS IN NEWBORN BABIES STUDIED BY ELECTRICAL IMPEDANCE Preliminary Results

Multiple frequency bio-electrical impedance analysis (MFBIA) may be useful for monitoring fluid balance in newborn infants or to provide early prediction of the outcome following perinatal asphyxia. A reference range of data is needed for identification of babies with abnormal impedance values. This was a cross-sectional observational study in 84 term and near-term healthy neonates less than 12 h postpartum. Whole body and cerebral MFBIA measurements were performed at the bedside in the post-natal ward. Gestational age, post-natal age, gender, birthweight, head circumference and foot length measures were recorded. Reference values for impedance at the characteristic frequency (ZC) and resistance at zero frequency (R0) are reported for whole body and cerebral impedance. Significant correlations (p < 0.05) were observed between whole body impedance and birthweight, footlength and head circumference. Females had a significantly higher whole body R0 than males. Cerebral impedance did not correlate significantly with any of the demographic measures and there were no gender differences observed for cerebral impedance. The reference range for whole body multi-frequency bio-impedance values in term and near-term infants within the first 12 h postpartum can be calculated from the footlength (FL) using the following equations: ZC = (942.9 − 4.818*FL) ± 124.6 Ω; R0 = (1042 − 4.520*FL) ± 135.5 Ω. For cerebral impedance the reference range is 29.5–48.7 Ω for ZC and 33.7–58.0 Ω for R0.

Reference values for whole body and cerebral multi-frequency bio-impedance data in neonates less than 12 h postpartum.

Transcephalic impedance in the neonate: An indicator of intracranial hemorrhage, asphyxia, and delayed maturation

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Transcephalic impedance in the neonate: An indicator of intracranial hemorrhage, asphyxia, and delayed maturation