Pediatric Annals

Neonatology in the NICU: Three New Techniques, Three Continuing Problems

Gordon B Avery, MD, PhD

Abstract

The neonatal intensive care unit has become a bewildering, highly technical care system which leaves even pediatricians arguing about the extent to which it is a savior or a Dr. Frankenstein. The journals are filled with new techniques that are in the pipeline, as well as discussions of complications and morbidities. This issue of Pediatrie Annals examines three much heralded new treatments with an eye toward putting them in their proper perspective. In addition, three chapters are devoted to morbidities and aftercare.

In their article on surfactant therapy in the newborn, Drs. James Kendig and Donald Shapiro compare the various candidate substances for surfactant replacement and the various indications that have been used clinically. Perhaps the most powerful results will be from multidose regimens, which as yet have had the least evaluation in high risk newboms. High-frequency ventilation is reviewed by Drs. Steven Boros and Mark Mamme I, who point out that although these new ventilator techniques may be lifesaving in individual infants, they also have problems and are not about to replace conventional ventilation in routine use. Billie Short and Andrea Lotze summarize the burgeoning experience with extracorporeal membrane oxygénation, demonstrating that it has gteat power to allow recovery from acute, transient cardiopulmonary failure, but must be used with discipline and restraint.

The asphyxiated newborn has been examined in the light of both animal studies and careful follow-up of asphyxiated babies. Lu-Ann Papile presents a common sense approach to management of hypoxic-ischemic encephalopathy, emphasizing that in severe cases, multi-organ failure complicates the cerebral insult. The role of cerebral edema is by no means as clear as was once thought. Gordon Avery and Penny Glass discuss the mysterious resurgence of retinopathy of prematurity (ROP) despite careful regulation of oxygen use. The survival of ultra-small prematures probably means that blindness from ROP will be with us for the immediate future. Lastly, Rebecca !chord lays out the needs of the NlCU graduate for aftercare, both somatic and neurodevelopmental. Pediatricians have a key role here, both as primary physicians and integrators of specialty services for the high risk infant.…

The neonatal intensive care unit has become a bewildering, highly technical care system which leaves even pediatricians arguing about the extent to which it is a savior or a Dr. Frankenstein. The journals are filled with new techniques that are in the pipeline, as well as discussions of complications and morbidities. This issue of Pediatrie Annals examines three much heralded new treatments with an eye toward putting them in their proper perspective. In addition, three chapters are devoted to morbidities and aftercare.

In their article on surfactant therapy in the newborn, Drs. James Kendig and Donald Shapiro compare the various candidate substances for surfactant replacement and the various indications that have been used clinically. Perhaps the most powerful results will be from multidose regimens, which as yet have had the least evaluation in high risk newboms. High-frequency ventilation is reviewed by Drs. Steven Boros and Mark Mamme I, who point out that although these new ventilator techniques may be lifesaving in individual infants, they also have problems and are not about to replace conventional ventilation in routine use. Billie Short and Andrea Lotze summarize the burgeoning experience with extracorporeal membrane oxygénation, demonstrating that it has gteat power to allow recovery from acute, transient cardiopulmonary failure, but must be used with discipline and restraint.

The asphyxiated newborn has been examined in the light of both animal studies and careful follow-up of asphyxiated babies. Lu-Ann Papile presents a common sense approach to management of hypoxic-ischemic encephalopathy, emphasizing that in severe cases, multi-organ failure complicates the cerebral insult. The role of cerebral edema is by no means as clear as was once thought. Gordon Avery and Penny Glass discuss the mysterious resurgence of retinopathy of prematurity (ROP) despite careful regulation of oxygen use. The survival of ultra-small prematures probably means that blindness from ROP will be with us for the immediate future. Lastly, Rebecca !chord lays out the needs of the NlCU graduate for aftercare, both somatic and neurodevelopmental. Pediatricians have a key role here, both as primary physicians and integrators of specialty services for the high risk infant.

10.3928/0090-4481-19880801-05

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