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Highlights from the Southeastern Association of Neonatolgists
Meeting at Marco Island, May 17-20, 2001
Neonatology: Past, Present and Future
Presented by Dr. Avroy Fanaroff, Rainbow Babies &
Children’s Hospital, Cleveland OH.
NICUs of the 70s:
- Erythroblastosis
- GBS sepsis
- IDM - birth defects, hypoglycemia
- RDS + PPHN in large premies
- Meconium aspiration
- Malformations
- Rhogam
- Screening and penicillin
- Fetal monitoring
- Antenatal Steroids
- CPAP
- Antenatal ultrasound
Issues in the 80s:
- Transcutaneous monitoring
- Technologic Improvements: better ventilators & monitors, CT, doppler echo, MRI,
ultrasound
- Surfactant trials
- Benzyl alcohol tragedy
- ECMO
Progress in the 90s:
- Surfactant therapy
- Antenatal steroids
- Folate to prevent NTDs
- Improved survival of micropremies
- Nitric Oxide therapy
- Fetal therapy
- "Back to Sleep" reduced SIDS
Therapies that have stood the test of time:
- Prophylaxis for ophthalmia
- Vitamin K to prevent hemorrhagic disease
- Parenteral nutrition
- CPAP, surfactant, & mechanical ventilation
- Phototherapy
Therapies that did not live up to their promise:
- IVIG for nosocomial infections
- Antenatal phenobarbital and postnatal indomethacin to prevent IVH
- Liquid ventilation
- Erythropoietin for premature infants
- Albumin for hypotension
- Steroids for chronic lung disease
- Reduced light or oxygen for ROP
- Cytokines for nosocomial infections
- Physical therapy
- Hyperventilation for PPHN
Therapies under evaluation:
- Hypothermia for asphyxia
- Aquaphor for skin integrity
- Glutamine as a nutritional supplement
- Surfactant-CPAP, permissive hypercapnia, and antoxidants to reduce lung injury
- The role of nitric oxide in preterm infants
- Fetal surgery for NTDs.
Current Issues:
- Prevention of major morbidities
- Preservation of brain function
- How to provide optimal nutrition
- Practicing evidence-based medicine
- Avoiding medication errors
- Providing adequate sedation & pain relief
- Enhancing the environment in NICUs
- Improving non-invasive monitoring
- Minimizing invasive procedures
Comment: This was a great review by one of the icons of neonatology. He really put
it all in perspective.
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