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.