Events in neonatology continue to move at a rapid pace. The initial impetus for neonatal intensive care was the development of appropriate technology for use with newborn infants, and improvements in technology continue with the possibility of successfully treating ever-smaller infants. However, important changes in attitudes toward care of high-risk patients have also marked the recent past. This report will document some of the recent changes in both techniques and attitudes that affect intensive care of the newborn.
The possibility that surfactant replacement could improve the outcome of newborns with respiratory distress syndrome (RDS) has intrigued neonatologists since the demonstration of its association with surfactant deficiency 25 years ago. A long period of mostly discouraging experimentation with insufflation of various surface-active materials followed. In 1980, Fugiwara and coworkers1 demonstrated in a landmark report that artificial surfactant—an extract of bovine surfactant with the addition of synthetic lipids—improved the outcome in