Rudolph's Pediatrics, 22nd Ed.

CHAPTER 38. Historical Perspectives

James M. Greenberg

The past 100 years has seen a dramatic transformation in attitudes about and care for the newly born infant.1 The sick or small neonate, once the object of pity and benign neglect, is now the recipient of substantial medical resources and improved outcomes. In the early 20th century, newborns and their mothers began to benefit from public health efforts that produced broad improvements in hygiene, infection control, and nutrition. Responsibility for newborn care, a traditional province of the midwife or obstetrician, moved to the scope of the pediatrician, who effectively advocated for improvements in clinical care.

By the 1960s, care had sufficiently advanced to warrant the full attention of specialized physicians focusing exclusively on the management of neonates. These neonatologists built upon earlier advances, developing principles for delivery room management, thermoregulation, assisted ventilation and respiratory support, nutrition support, noninvasive monitoring techniques, and effective treatment strategies for unique problems such as hyaline membrane disease and retinopathy of prematurity.

Despite remarkable progress, challenges remain. Like other areas of medicine, the history of neonatology is littered with therapeutic misadventures.2-4 While gestational age-specific survival is better than ever, morbidity is also increasing among survivors. The rising rate of preterm birth in the United States is equally worrisome and threatens to blunt the remarkable successes of previous decades. Solutions will require renewed focus on public health as well as clinical and basic research efforts. The future of neonatology depends on improving outcomes for our survivors through rigorous attention to outcomes and application of evidence-based practice.