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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The changing face of neonatal intensive care for infants born extremely preterm (<28 weeks' gestation)
1Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Research Office, Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Neonatal intensive care for extremely preterm infants has evolved significantly, with survival rates increasing due to advancements in treatments and evidence-based practices. Learning from past errors is crucial for future improvements in infant care.
Area of Science:
- Neonatology
- Pediatric Intensive Care
Background:
- Neonatal intensive care for extremely preterm infants (<28 weeks' gestation) has undergone substantial transformation over the last 60-70 years.
- Early 20th-century care had limited survival rates, contrasting with the increasing survival observed in the latter half and into the 21st century.
Purpose of the Study:
- To review pivotal changes in neonatal intensive care for extremely preterm infants.
- To analyze the consequences of these changes and identify lessons learned from past mistakes.
Main Methods:
- Historical review of neonatal intensive care practices.
- Discussion of evolving attitudes, physical environments, staffing, and core treatments like oxygen therapy and assisted ventilation.
- Emphasis on the integration of evidence-based care.
Main Results:
- Dramatic improvements in survival rates for extremely preterm infants.
- Identification of critical shifts in care approaches, including changes in medical interventions and care delivery models.
- Recognition that past interventions, while improving survival, also led to unintended negative consequences.
Conclusions:
- Neonatal intensive care continues to advance, driven by ongoing research and technological innovation.
- Learning from historical successes and failures is essential to prevent repeating past mistakes.
- Future evolution of neonatal intensive care must prioritize patient safety and optimize long-term outcomes for extremely preterm infants.
Abstract:
Neonatal intensive care for infants born extremely preterm (<28 weeks' gestation) has changed dramatically over the past 60-70 years. From little care being available and few infants surviving in the first half of the 20th century, more intensive care and rapidly increasing survival rates followed in the second half, and have continued to rise into the 21st century. However, mistakes were made along the way. The purpose of this article is to recollect some of the pivotal changes in neonatal intensive care of infants born extremely preterm, and the consequences of those changes. Changes in attitudes, the physical environment, staffing, and basic treatments, such as oxygen and assisted ventilation, and evidence-based care are all discussed. Neonatal intensive care will continue to evolve, but in so doing we must learn from past mistakes in order to avoid repeating them.
