Consultant’s View

The Beginning of the Third Millennium
With the celebrations for the end of the last Millennium now behind us, it is appropriate that the changes and advances in many walks of life are reviewed. The care of the newborn infant has dramatically altered throughout the Millennium, as has the practice of medicine. It may be worth considering some of the changes that have occurred in our branch of medicine. The last thousand years have witnessed the negligible level of newborn care as seen at the beginning of the Millennium through the innovative care of lying-in hospitals of the medieval monastic chivalrous orders to the rapidly advancing world of neonatalogy, one of the most recently established branches of medicine. The following is a personal view of some of the most important changes that have occurred in the last 30 years that have altered how our babies are cared for:

The ability to help babies with their breathing
Artificial ventilation has only become established for babies since the 1970s. The practice of supporting a baby to breathe has dramatically altered our medical ability to keep sick babies alive, particularly those born before 34 weeks of gestation. Premature babies were not uncommon before 1970. Winston Churchill was born prematurely in 1874, but the chances of survival have increased dramatically. Techniques of ventilation have become increasingly sophisticated with the advent of flow driver CPAP and the appearance of oscillators.

The ability to adequately feed sick newborn babies
Nutrition is one of the most crucial aspects of newborn care. Increasing knowledge of the nutritional requirements of babies has allowed us to provide artificial intravenous feeding, as well as a host of artificial milk products. An understanding of the benefits of breast milk has encouraged breastfeeding and the use of breast milk wherever possible. Our Unit is fortunate to have the breast milk bank to provide milk for sick infants who require this milk, particularly when their mothers are unable to provide milk. The Unit is fortunate to receive support from our Specialist Dietician, Brenda Harris, who also supports the neonatal graduate clinic, where her help is invaluable in preventing feeding difficulties arising in some infants.

The use of surfactant replacement
Over the last 12 years, the use of either animal or a rtificial surfactant in premature babies has radically reduced the amount of time that babies have needed artificial ventilation. There is a paucity of surfactant in the premature infant’s lungs that makes breathing much harder work. Our ability to replace this effectively is a grade advance, although an expensive one, as a single vial of surfactant costs about £400!

The use of steroids antenatally
Studies have shown that administration of steroids to mothers who threaten to go into labour prematurely allows their babies to mature their lungs and produce more surfactant naturally. This has also reduced the need for ventilation.

Our understanding of the physiology of babies has helped both doctors and nurses to plan effective care.

The knowledge of why a baby becomes jaundiced has allowed effective treatments, such as phototherapy. However, some advances are purely by accident, and the reason for their success then requires careful analysis. Other areas of care include the need to avoid excessive handling of the smallest and most critically ill babies; the use of “kangaroo” care of skin-to-skin contact; the optimum use of incubators; and the special metabolism of babies, allowing staff to judge the amount of salt and fluid needed in intravenous fluids.

Our ability to treat infections
Since the discovery of penicillin in the 1940s, the list of antibiotics has grown rapidly. Although the use of antibiotics has many detractors, none of these will be parents of premature or sick newborn infants. Most babies who are admitted to the Unit require antibiotics, and many of the smallest require multiple courses of antibiotics to treat infection. They are truly life-savers. Sadly, not all of our babies with infections survive, but the many who do have Sir Alexander Fleming to thank when he studied the mould in his laboratory that eventually yielded penicillin.

The ability to monitor babies’ progress
All those familiar with the Neonatal Unit will have seen the vast array of colourful digital displays on the banks of monitors that provide minute-by-minute information about the wellbeing of their babies. Routine brain scans are performed using ultrasound machines to look at babies’ brains to detect any evidence of brain haemorrhage or other similar problems.

The ability to deliver the care necessary
This encompasses the technology of tiny drip needles, pumps that can deliver tiny quantities of drugs, as well as the skill and dedication of the nursing and medical staff who work around the clock to care for their patients. I wish to thank Born Too Soon for their support in helping the Neonatal Unit to purchase such equipment as the new oscillator ventilator. Their continued support is greatly valued by all on the Unit.

Whilst this is a personal view from which my colleagues may differ in some detail, I am sure that they would all agree that the last 30 years have been exciting in terms of being able to save sick babies. Who knows what the next 30 years will provide!

Consultant Paediatrician