Foreword

Although this article is published in the Fetal and Neonatal Edition, it was originally commissioned to be of interest to general paediatricians who are not specialists in neonatology, but who are responsible for the provision of much of the UK’s neonatal care.

Neonatal medicine continues to make rapid progress. Babies born at 26 weeks of gestation now have a better than evens chance of survival, a remarkable improvement compared to even a decade ago. The combination of antenatal steroids and postnatal surfactant has significantly reduced mortality and the risk of intracranial haemorrhage. Artificial ventilators have become more and more sophisticated and the role of high frequency oscillation (HFOV) as rescue treatment is now established. Infections still contribute to many premature labours, and although the results of the ORACLE trial are still awaited, intrapartum antibiotic prophylaxis against neonatal group B streptococcal infection is gaining widespread acceptance. For term infants with persistent pulmonary hypertension (PPHN), nitric oxide (NO) has made a rapid leap from the laboratory to the cotside and has already proved to be effective treatment.

This review aims to provide a brief update of the most important recent changes in neonatal medicine.

Surfactant treatment

Exogenous surfactant has now been in use for nearly a decade. Surfactant reduces neonatal mortality from respiratory distress syndrome (RDS) by about 40% and reduces complications like air leaks by up to 60%.1-3 The combination of postnatal surfactant with antenatal steroids is more effective than either treatment alone.4 Surfactant treatment has no effect against chronic lung disease (CLD), gross maternal haemorrhage–intraventricular haemorrhage (GMH–IVH), and patent ductus arteriosus (PDA).5 The controversies that remain are not to do with surfactant use in typical RDS, but are about which product is superior; whether there is a lower gestation or weight limit at which surfactant should be withheld; and …