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The Van Deventer Lecture. 'Prematurity: the changing scene'.

P M Dunn1

  • 1Department of Perinatal Medicine and Child Health, University of Bristol, Southmead Hospital, U.K.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|October 1, 1989
PubMed
Summary
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Neonatal intensive care has evolved significantly, improving survival for premature infants. Future challenges include protecting preterm infants and preventing premature birth.

Area of Science:

  • Neonatology and Perinatal Medicine
  • Pediatric Critical Care

Background:

  • The institutional care of newborns, particularly premature infants, originated in Europe over a century ago.
  • Care shifted from physicians to nurses and back to pediatricians, influenced by wartime advancements and evolving societal views on family size and infant survival.

Observation:

  • Therapeutic breakthroughs like blood transfusions and antibiotics, alongside enhanced understanding of newborn physiology and pathology, spurred pediatrician involvement in neonatal care.
  • Increased access to birth control and a desire for fewer, surviving children shifted focus towards neonatal survival.

Findings:

  • Advancements in neonatal intensive care have progressively lowered the threshold of viability to approximately 22 weeks' gestation and 500g birthweight.
  • Significant challenges persist regarding the short- and long-term morbidity of preterm infants, associated costs, and ethical considerations in intensive care provision.

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Implications:

  • Future efforts must focus on protecting preterm infants from perinatal damage.
  • The primary future challenge is the prevention of premature delivery itself.