Neonatology at a Glance

Tom Lissauer, Avroy A. Fanaroff, Lawrence Miall, Jonathan Fanaroff, Tom Lissauer, Avroy A. Fanaroff, Lawrence Miall, Jonathan Fanaroff

• Publisher: Wiley-Blackwell
• Year: 2020
• ISBN:
  9781119513223
• Edition: 4
• Topic: Medicine
• Subtopic: Perinatology & Neonatology

Written by a team of leading international experts, Neonatology at a Glance provides a concise and easy-to-read overview of neonatal medicine. Each topic is clearly explained over a two-page spread, aided by numerous diagrams and illustrations. It has been extensively updated to include recent advances in perinatal medicine, genetics, respiratory support, therapeutic hypothermia, antimicrobial stewardship, and family integrated care. The book covers the wide range of problems encountered in looking after newborn babies, from normal newborn infants to the complexities of neonatal intensive care.

Neonatology at a Glance:

• Provides up-to-date coverage of the important conditions you will encounter, including neonatal resuscitation and care of preterm infants
• Covers challenging topics including pain, ethical issues, patient safety, evidence-based medicine, and palliative and end of life care
• Includes details of a wide range of practical procedures, including less invasive surfactant administration, cranial ultrasound, brain monitoring and neuroimaging, and neonatal transport

Neonatology at a Glance is the perfect guide for all health professionals looking after newborn infants, including pediatric trainees, medical students, neonatal nurse practitioners and neonatal nurses, therapists, and midwives. For neonatologists, pediatricians, and neonatal lecturers, it is a valuable resource to assist with teaching.

1 Milestones in neonatology

The care of newborn infants has evolved over the last century from simple and empirical care to modern, evidence‐based, high‐tech medicine. Neonatal mortality has correspondingly declined dramatically from 40/1000 live births in 1900 to <4/1000 in the US and UK. Improved obstetric care and maternal health and nutrition have also contributed. It was only in the 1950s that medical care of healthy and sick newborn infants was transferred from obstetricians to pediatricians. The specialty of neonatology developed only in the 1960s, and the first certifying examination for physicians in the US was held in 1975.

Thermal regulation

• • 1890s: Tarnier in France showed that a warm, controlled environment reduced mortality of infants <2 kg from 66% to 38% (Figure 1.1).
• • 1893: Budin, Tarnier's student, established the first unit for premature babies in Paris, emphasizing thermal regulation and breast‐feeding.
• • Early 1900s: Premature babies in incubators were exhibited in fairs around Europe and the US (Figure 1.2).
• • 1950s: Silverman in the US conducted elegant randomized controlled trials to confirm the beneficial effects of thermal control (including humidity) on mortality.
• • 2000s: Heat loss at delivery of extremely preterm babies minimized by plastic wrapping.

Figure 1.1 The Tarnier incubator. The water was heated by the oil flame. Heated air circulating around the incubator kept baby warm.

Figure 1.2 Incubators with premature babies at the Pan‐American Exposition, Buffalo, New York in 1901.

Source: Silverman WA. Incubator‐baby side shows. Pediatrics 1979; 64: 127. Courtesy of the American Academy of Pediatrics.

Nutrition

• • 1880s: Tarnier and Budin recommend early feeding and intragastric “gavage” feeding via a rubber tube inserted through the mouth.
• • 1907: Rotch in US introduces infant formula. Breast‐feeding declines as some believed formula was superior.
• • 1940s: Gavage feeding via a nasogastric tube used in neonatal units.
• • 1940s: Feeding of preterm infants delayed up to four days to avoid aspiration. Adverse effects (hypoglycemia, increased bilirubin and impaired development) recognized only in the 1960s, and early feeding reintroduced.
• • 1960s: Parenteral nutrition (PN) introduced by central venous catheter, then via peripherally inserted central catheters (PICC) lines.
• • 1960s: Infant formula associated with neonatal tetany from hypocalcemia and hemolysis from vitamin E deficiency.
• • 1980s: Development of special formulas for very low birth‐weight infants.
• • 1980s: Resurgence of use of breast milk. Human milk fortifiers developed for preterm infants.
• • 2000s: Addition of long‐chain polyunsaturated fatty acids (LCPUFA) to formula.

Rhesus hemolytic disease

Kernicterus, from bilirubin deposition in the brain in rhesus disease, was first described in 1938. Exchange transfusions became a common procedure in neonatal units and saved an estimated 8000 lives/year in the US alone.

• • 1925: Hart describes first exchange transfusion – blood given via saphenous vein, removed from anterior fontanelle.
• • 1940: Landsteiner discovers rhesus factor.
• • 1945: Coombs develops Coombs test (direct antiglobulin test [DAT]) to detect rhesus agglutinins.
• • 1947: Diamond describes exchange transfusion via umbilical vein with rubber catheter.
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