neonatology

neonatology, the study of the care and treatment of newborn infants, especially those born prematurely or with birth complications. The field is a subsection of pediatrics, although the path to becoming a neonatologist involves additional specialized training beyond that required of a pediatrician.

History

Although the specialty has roots as early as 600 bce, the term neonatology was popularized in 1960 by American pediatrician Alexander Schaffer (also spelled Shaffer or Schaeffer) in his book Diseases of the Newborn (1960), one of the cardinal pieces on the subject. Since then, neonatology has led to the significant advancement of neonatal intensive care units (NICUs) and the betterment of newborn survival rates. In 1960, for example, a 1 kg (2.2 pounds) infant had a 95 percent mortality rate; by 2000 this had reversed to a 95 percent survival rate.

Incubators for premature infants were first publicly exhibited in 1896 at the World Exposition in Berlin, garnering attention for the machinery. The emergence of these incubators, which were designed to regulate temperature and humidity, directly opened the door for the invention of the NICU. Early advances in neonatology were most apparent in these care units, where the development of increasingly specialized technology vastly improved treatment and survival for critically ill infants. In 1960 Mildred Stahlman and colleagues at Vanderbilt University established the first modern NICU, complete with continuous electrocardiography (ECG or EKG) monitoring, mechanical ventilation, umbilical lines, and on-site measurement of blood gases. Though neonatal units had been previously established in the United States and United Kingdom, they had not yet utilized such sophisticated monitoring devices, which are now considered essential for the care of infants with respiratory distress syndrome (RDS). At the time, RDS was a common and often fatal diagnosis for premature newborns.

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In 1970 neonatologist and pediatric anesthesiologist George Gregory was the first to use continuous positive airway pressure (CPAP) machines for newborns with RDS, further improving their survival rate. From there neonatologists built interhospital transport systems, enabling the transfer of infants and the complex machinery they rely on to survive. These transport systems are essential for providing critically ill newborns with specialized care when it is not available at their birth hospital. The field continued to grow with the advent of diagnoses such as fetal alcohol syndrome and the use of surfactant, which is a chemical compound that decreases tension in the body, to treat respiratory illnesses. Other important milestones include work by American physician Virginia Apgar, who in 1952 developed the Apgar score to assess newborn health immediately following birth, and the introduction in 1975 of an official board certification process for neonatologists. Work by neonatologist Philip Sunshine throughout the 1960s and ’70s led to the development of systems for feeding premature newborns who are unable to digest breast milk.

Modern developments

Today neonatologists use the aforementioned tools to diagnose and treat a broad range of conditions in newborns, including heart disease, brain hemorrhage, and liver malfunction. In addition, researchers emphasize the importance of maternal health in preventing premature birth through collaboration with organizations such as March of Dimes, a nonprofit focused on improving maternal and neonatal health. This has led neonatologists to work in conjunction with perinatologists, who study the health of mothers and babies during pregnancy.