PEDIATRICS
NEONATOLOGY: CARING FOR THE TINIEST OF PATIENTS
AUTHOR John Roberts, MD
While records can be found
across the millennia, in all
countries of the world, of
men and women providing
rudimentary medical care to
newborns, Western societies
did not take an interest in
newborn survival until the
middle of the 19 th century. European countries and the US, their
populations ravaged by wars, struggled to meet the manpower needs
of the industrial revolution and to repopulate armies. National
wealth and security depended on a large healthy population, and
countries could no longer afford the high rates of infant mortality.
Registration of all births became mandatory in England in 1856,
at which time the infant mortality rate was nearly 25%. In the US,
the rate was 16% when the US Census Bureau was created in 1902.
Today in the US, the infant mortality rate is 5.8 per 1,000 live births
(0.58%). This improvement has been largely due to advances in
nutrition and sanitation.
As overall infant mortality improved, individuals began focusing
on the survival of the 10% of infants born prematurely. This required
medical expertise and technology not previously available. Perhaps
the greatest invention in the field is the incubator. Unable to maintain
their own body temperature outside the uterus, many prematurely
born infants developed hypothermia, became feeble and died. The
original incubators were adapted from those in chicken hatcheries
in Europe in the 1800s. Martin Couney successfully exploited the
public’s curiosity in the 1930s by displaying premature infants in
incubators at a permanent exhibit at Coney Island and at world
fairs. 1 The price of admission was 25 cents and supported the care
of the infants.
The first pioneers of the field of newborn medicine were often
obstetricians and midwives. A few physicians proclaimed themselves
to be pediatricians, though this title had no standardization in the
US until the American Board of Pediatrics, the American Medical
Association and the American Academy of Pediatrics established
training requirements and a certification exam in 1935.
It was not until 1960 that the term “neonatology” was first used;
some say it took the death of a president’s son to light fire to the
discipline. In 1963, Patrick Bouvier Kennedy, after being born at
34 weeks gestation and weighing 2,100 g (4 lbs 9 oz), died of respiratory
complications of prematurity. His death led to increased
public awareness of prematurity and its consequences, increased
funding for research, and the development and miniaturization of
technologies appropriately sized for newborns.
Key among the developments has been the miniaturization
of laboratory testing. The volume of blood or plasma needed for
common laboratory tests in the adult was unacceptable in caring
10 LOUISVILLE MEDICINE