The value of effectiveness of neonatal intensive care: its relationship to perinatal mortality and morbidity

Evidence has accumulated from a number of sources regarding the efficacy of neonatal intensive care in effecting overall reductions in neonatal mortality. Such effectiveness is in direct proportion to the degree of organization of the systems that are used to provide it and their relationship to the regional organization and distribution of such neonatal intensive care centers. The expectations that such neonatal intensive care practices would, however, result in an increased morbidity, particularly in relationship to handicap and developmental delay, is not supported by any concrete evidence. On the contrary there is an increasing suggestion that the effectiveness of such practices and the centers in which they are carried out is reflected in an overall decline in the incidence of severity of morbidity and that the practices themselves have resulted not only in greater numerical survivors but in a better overall quality of those infants as well. This relationship is certainly for surviving newborn infants born at term and for low birthweight infants in excess of 1500 grams. It needs to be more critically evaluated in the smaller low birth weight infant in whom survival after protracted illness is associated in greater frequency with a variety of major and minor handicapping conditions.