Nutrition for Preterm Infants: 75 Years of History.

As technology has advanced, survival rates of preterm infants have improved dramatically. Human milk was the primary source of enteral nutrition during the early days of neonatology, but the HIV/AIDS epidemic resulted in an increased use of preterm formula. More recently, the benefits of human milk were rediscovered, resulting in increased use of donor human milk as well. The awareness that human milk does not contain the amounts of nutrients to meet the high requirements of infants born premature resulted in the development of human milk fortifiers. The development of these fortifiers is still ongoing, as are alternative methods of pasteurization of donor milk. Those initiatives will increase the use of human milk with consequently short- and long-term benefits for preterm infants.

The effect of Soranus of Ephesus (98-138) on the work of midwives.

BACKGROUND: In the Roman period, midwives continued to play an important role in female health care primarily in the attendance of women birth. In the second century AD, midwives' education received a significant boost thanks to the distinguished physician Soranus of Ephesus. AIM: To reveal the work and important contribution of Soranus of Ephesus in the practice of midwifery. METHODS: The main bibliographic sources concerning Soranus' work on midwifery have been investigated and analysed. FINDINGS: In his work, Soranus described the main characteristics and skills of a midwife. In the practice of obstetrics, he performed the manoeuvre which was later called "turning the foot" and introduced the birth chair. His contribution in neonatology is also of a great importance as he provided the earliest newborn assessment. CONCLUSION: Soranus' work contributed in the education of midwives and influenced the practice of obstetrics till the Middle Ages.

The evolution of neonatology.

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.

Neonatology in Singapore: the way we were, the way forward.

Singapore has a maternity hospital since 1924, but for many decades the newborns could only receive basic care. Neonatal and perinatal mortality rates were high. Marked improvement in neonatal care began from the 1980s when many neonatal departments were set up to provide intensive care. Improved socioeconomic status, better healthcare facilities, effective infection control, immunisation programmes and availability of potent antibiotics contributed to the decline of perinatal and neonatal mortality. Following the implementation of the glucose-6-phosphate dehydrogenase (G6PD) deficiency screening programme, severe neonatal jaundice and kernicterus were largely reduced. Exchange blood transfusions initiated in the 1960s and phototherapy in the 1970s had saved many babies. Kernicterus is almost not seen now. With more neonatal-trained staff, organised resuscitation teams, advances in respiratory management and better monitoring equipment, more babies have survived. Closer cooperation between obstetricians and neonatologists was a great leap forward towards perinatal medicine. Physicians should endeavour to reduce the incidence and prevalence of birth defects and metabolic errors. Perinatal asphyxia should be promptly detected and managed effectively, including neuroprotective strategies. There should be markers to predict the outcome of asphyxiated babies for decision-making. Neonatologists should be mindful of safe introduction of new technologies and rapid diagnostic techniques for infections, including group B streptococcal screening and chemoprophylaxis when required. Other current issues include prevention of major morbidities, preservation of brain function, improved neurodevelopmental outcome of premature babies, use of blood substitutes, optimal nutrition, fetal surgery, evidence-based medicine, better information systems, avoidance of medication errors, adequate sedation and pain relief of the baby, and the use of nitric oxide. One should bear in mind the need to enhance the neonatal intensive care environment, improve non-invasive monitoring and minimise invasive procedures. Physicians should prioritise neonatal care for their country and utilise less costly neonatal care. Ethical issues in neonatology that arise following advancement in neonatal care deserve attention. Advances in life sciences, such as the completion of the human genome project, cloning of tissues and organs, human stem cell research and technology, gene therapy, deoxyribonucleic acid vaccines and nanomedicine, should benefit neonatology.

Reflections on errors in neonatology: I. The "Hands-Off" years, 1920 to 1950.

This series discusses errors in neonatology since the 1920s. Three historical periods are defined: the "Hands-Off" years, 1920 to 1950; the "Heroic" years, 1950 to 1970; and the "Experienced" years, 1970 to 2000. In this article, the "Hands-Off" years, we discuss lowered thermal environment, supplemental oxygen, initial thirsting and starving, synthetic vitamin K, SMA formula, and diaper markings.

A review of newborn medicine in America: European past and guiding ideology.

The beginnings of newborn medicine and its rapid advance in America since the early twentieth century are reviewed through presentation of ideas that have influenced the givers of care. Newly born infants attained patient status at the end of the 19th century when Budin gave them hospital charts and Ballantyne designed the blueprint for continuity of maternal-infant care. These achievements gave impetus to the task of preserving infant life. In 1915, the United States established a birth registration area permitting calculation of infant mortality rates. These rates became the guide and yardstick for measuring progress in newborn care. Since 1915 infant mortality has decreased tenfold as survival increased successively in the postnatal infant, the neonate, and recently in the premature. Pediatricians began to supervise newborn nurseries after World War I. During depression years, national efforts were expended for the premature. After World War II, pediatricians moved close to birth, assessing and treating in the delivery room. Special care and intensive care nurseries sprang up in the 1960s. In the past 25 years, improvements in ventilation and life support systems have enhanced survival of compromised and immature infants. Today, newborn medicine is spectacularly successful in lowering neonatal mortality but is beset by costs, ethics, legal concerns, and the burden of survival morbidity. Controversy such as exists today is not new to newborn medicine; it has been its constant companion throughout history.