Treating Premature Babies: What Does The Future Hold?

Predicting the future is always a dubious endeavor. If I could really do it, I might have a slightly different job. Nonetheless, it is worth considering where we were not long ago and where we might be in the future.

First, where have we come? Remarkably, the last 20 years has seen relatively incremental technological changes. Slightly better breathing machines and the use of a few important new medications such as inhaled nitric oxide. The most important “low tech” approach has been the use of human milk for our small or sick babies. We have learned that none of our technology can beat the incredible value of human milk for infants and that this is especially true for premature ones. We have challenges as I’ve noted before, but overall we are thrilled to see an era in which we are able to support mother’s breastfeeding or providing their milk for their baby that they have expressed with a pump. We offer EVERY baby in the NICU at Texas Children’s Hospital or the Pavilion for Women donor milk if there is not enough of their own mothers milk available to meet their needs.  This is a major change in thought in the NICU world, but is based on very solid scientific evidence.

For the future, I do not think we are headed towards some sort of “artificial womb” in which we can raise fetuses to full term from the start or even from the beginning of the second trimester. Over the last 10-15 years, we have improved our care of very small infants, such as those born at 23 and 24 weeks gestation. But we still have a long way to go with these infants and have not really lowered the gestational age of survival much in recent years and I see little likelihood that will happen.

What I believe will happen is that we will continue to focus on improving the short and long-term outcomes of babies who are born prematurely or with other major health problems. This is happening now, using “high tech” approaches or a mix of high and low tech approaches. For example, one high tech approach is new forms of breathing machines for babies (called mechanical ventilators) that breathe with the baby’s breathing rhythm, decreasing the damage that have historically been associated with ventilation.

Neonatologists work with a wide range of other groups in caring for infants. This includes communicating with pediatricians to help us with the care of healthy or slightly ill newborns. It also includes working with nurses and others who assist us around the clock in every aspect of neonatal care. I do not see any shortening of pediatric specialty training in the near future. As with all pediatric specialists, the challenge of increasing student loan debt will continue to weigh on our trainees and new doctors. We need to work on decreasing that debt burden and ensuring that we train enough of all pediatric specialists.

Neonatologists by tradition are all “generalists” in the field. There is no formalized sub-specialty training in areas such as neonatal pulmonary, nutritional, or endocrine/metabolic diseases. In general, infants who need specialized care in these areas are managed together by consulting with the appropriate pediatric specialty service. In the future, I believe these relationships will become more formalized and hopefully regionalized. That is, a baby who has severe chronic lung disease anywhere in our region can be sent to Texas Children’s Hospital where we will have a multidisciplinary team of experts in this problem to manage them.

Finally, I think that we have made huge strides in developing neonatology as a family-centered specialty. Our physicians work closely with families in caring for babies and developing care plans and overall plans for our neonatology program. This trend will undoubtedly increase and we will see parents taking an increasing role in taking care of their infants, even while still in the NICU. This change is critical so we can improve the transition from NICU to home and do our best to keep our babies at home after their initial hospitalization.

About Dr. Steven Abrams, Neonatologist

I am the program director for the neonatology fellowship for Baylor College of Medicine and Texas Children’s Hospital. My academic interests include absorption and metabolism of dietary minerals in infants and children and nutritional policies and interventions to prevent and treat malnutrition in developing countries. My specialties are neonatology and nutrition. You can follow me on Twitter at @stableisotope.
Posted in Breastfeeding, Neonatology, Research

One Response to Treating Premature Babies: What Does The Future Hold?

  1. Thank you for a great article, you really put things in perspective! Neonatology has come a long way, but it’s humbling to realize that all of our technology can only approximate what mom can provide.

    You really struck a chord with me regarding neonatologists as “generalists.” Being able to touch on all subspecialties makes it very interesting for me and is one of the main reasons I chose to sub-specialize in the field. But I think you’re right in believing there will be sub-sub-specialized neonatal pulmonologists etc. In pediatrics residency, we’re taught that “kids aren’t just little adults,” that some things in adult medicine don’t apply and that there are things that happen to children that don’t happen to adults. Similarly, I’ve found the NICU to be very different from my experiences in the general children’s hospital, and that “neonates aren’t just little kids.” I shudder to think that *formal* medical training could be any more prolonged (but we’re all life-long learners!) but it does make sense.

    I too am proud of family centered care and continually try to improve my own practice. After speaking with families, one of my mentors, a pediatric hematologist-oncologist, always asks, “since I have a student/resident/learner with me, is there anything you want him/her to remember going forward in training?” I’ve started asking it for my own practice as a resident, and have been told [obvious] things like “be gentle and kind” and “don’t wake a sleeping baby,” but I’ve also been called out for using “big words” when I thought I was using “regular words” and have had the question turned around on me, “what do *you* think you should remember from taking care of my child?” It definitely makes me re-evaluate how I interact with families. And in the nursery or the NICU, I think using the baby’s name is essential to being family-centered. One thing that continually irks me is that in our EHR, babies born in the hospital always appear as “Babyboy [mom's last name]” and there’s no way to change it… even in some of the children who have been hospitalized since birth and are now months old!

    Thank you again for your article!

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