The last fifty years of neonatal surgical management

Neonatal surgical mortality has steadily fallen over the last five decades. Improved survival does not appear to be related to the introduction of new operative procedures. Most of the basic procedures were developed by 1960. Eight developments appear to be responsible: (1) The growth of pediatric s urgery resulted in widespread availability of neonatal surgeons and dissemi nation of knowledge about newborn surgical emergencies. (2) The parallel gr owth of pediatric anesthesia, beginning in 1946, provided specialized intra operative management of the neonate. (3) Understanding neonatal physiology is the key to successful management; major advances occurred between 1950 a nd 1970. (4) New inventions revolutionized patient care; the transistor (19 47) made it possible for medical devices to sense, amplify and control phys iologic responses and opened the communication and computer age. (5) Neonat al mechanical ventilation had a prohibitive mortality and was seldom utiliz ed; the development of CPAP and a continuous flow ventilator in the 1970s a llowed safe ventilatory support. (6) Total parenteral nutrition (1968) prev ented starvation that frequently affected infants with major anomalies. (7) The effective treatment of infection began with the clinical use of penici llin (1941); antibiotics have reduced mortality but infants suffering from the septic syndrome have a prohibitive mortality; cytokine, proinflammatory agent research, and the development of anti-inflammatory and blocking agen ts in the 1980s have not affected mortality. (8) The establishment of newbo rn intensive care units (1960) provided an environment, equipment, and staf f for effective physiologic management. Am J Surg. 2000;180:345-352. (C) 20 00 by Excerpta Medica, Inc.