NICU during 1960

FOREWORD

In 1960, the idea of having a special intensive care unit for newborns—a neonatal intensive care unit

(NICU)—represented a developmental milestone for the field of neonatology. With the increased

sophistication developed since then, doctors now are able to save the lives of many premature or

desperately ill newborns who in the past would have died soon after birth. The result is that the U.S. infant

mortality rate has shown a steady decrease since the NICU first came into widespread use a quarter of a

century ago and, concomitantly, survivors have fewer sequelae.

The widespread access to NICUs based on the existence of regionalization has allowed the establishment

of a national network of technologically advanced NICUs. Under regionalization, centrally situated

hospitals maintain one or more NICUs available to all babies of high-risk mothers and to critically ill

newborns referred from other hospitals located within a certain area. Babies born at hospitals not equipped

with state-of-the-art facilities or without experts in perinatal medicine on their staffs are thus ensured

access to the best possible neonatal care if needed. Regionalization represents nationwide access to health

care in the true sense of the term.

Although the ability to sustain premature or sick infants is a significant medical advance, the ultimate goal

is to eliminate the need for NICUs altogether. As with most, if not all, medical technologies, the benefits

of neonatal intensive care are not achieved without certain risks. These risks run the gamut from

inconsequential to deadly. Some premature babies born too small to survive on their own may have no

apparent problems at first. Some, however, may survive only to suffer severe mental and/or physical

handicaps later in life. Others, despite the best of neonatal intensive care, may not survive at all. In light of

these critical risks, it is clear that, as always, prevention is far better than any cure.

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Superficially, eliminating the need for NICUs appears to be relatively easy: simply reduce the number of

low-birth-weight infants. But as any neonatologist or obstetrician knows, that is not a simple task. From

steadily increasing numbers of births to teenage girls who receive little or no prenatal care, to smoking and

other forms of substance abuse during pregnancy, the odds against successfully eliminating low birth

weight are seemingly momentous. The rate of low birth weight births has remained virtually constant over

the past 20 years.

A mere 30 years ago, a description of today’s highly advanced state of neonatal care would have been met

with disbelief. Yet we now know what is possible. Perhaps the next 30 years will bring about an equally

miraculous decline in the incidence of low birth weight and its attendant problems. With education and

superb prenatal care for all pregnant women, the goal is attainable.

The following essays present the history and development of the neonatal intensive care unit. Written by

pioneers in the design and implementation of neonatal intensive care who shared their experience and

expertise at the National Institute of Child Health and Human Development’s Child Health Day

symposium, they not only document the past, but give one hope for the potential of the future.

Sumner Yaffe, M.D.

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Neonatal Intensive Care

http://www.neonatology.org/classics/nic.nih1985.pdf

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