When a baby was born at 24 weeks in Hamilton, Ont., a few years ago, his fate was uncertain. Despite the challenges, physicians at McMaster Children’s Hospital were able to keep him alive. Not only did he survive but also he developed into a healthy baby who took his first steps before he was a year old.

Dr. Christoph Fusch, a Professor of Neonatology at McMaster University and the first person to hold the school’s Jack Sinclair Chair in Neonatology, says he was delighted with the turn of events but he is quick to note that the outcome might have been dramatically different just ten years earlier. The baby might have received only palliative care.

“We now realize that not all premature babies are sick babies."

“When I started working in neonatal care in the late 1980s, it was challenging to treat a baby born at 29 weeks (11 weeks before full term) but that is not a big deal anymore,” says Fusch. “We now have the ability to treat babies born five weeks earlier than that.”

Since the specialty of neonatology developed in the 1960s, neonatal care has improved by leaps and bounds. Thanks to advances in technology and medicine, healthcare providers are now better able to treat premature babies for a
myriad of problems, ranging from brain and heart problems to infection.

Particularly noteworthy are advancements in the treatment of breathing problems, which are common in premature babies.  In the late 1980s, the pharmaceutical industry produced surfactant. The substance, which helps lungs stay inflated, is found in healthy lungs but is lacking in the undeveloped lungs of many “preemies.” Their lungs usually improve when this substance is delivered through a breathing tube.

Today, healthcare workers also have access to other drugs that help critically ill babies breathe. When used with a ventilator, a gas called nitric oxide treats respiratory failure by widening blood vessels in the lungs.

Paradigm shift in treating ‘preemies’

Also in recent years, there has been a paradigm shift in neonatal care. Physicians are starting to take a “less is more approach” to treating premature babies. “We now realize that not all premature babies are sick babies,” says Fusch. He points to respiratory care as an example. While all babies need support in this area, they don’t all need mechanical ventilation. “The idea is to start with less and shift to more care, only if necessary,” he explains, adding that this approach requires more vigilance on the part of health care providers.

Despite these and other advancements, care of premature babies could be improved in many ways. Dr. Shabih Hasan, Professor and Neonatologist with Alberta Health Services, hopes to see more comprehensive neonatal monitoring for one. In the Neonatal Intensive Care Unit (NICU), the baby’s various systems (circulatory system, nervous system, etc.) are monitored separately but if all the systems were monitored together, he says, the big picture would be clearer and that would lead to improved treatment.

Hasan is confident that development will come with improvements not just in technology but also in administration — the creation of comprehensive databases of information that are accessible to a greater number of physicians.

Both Fusch and Hasan expect neonatal care to improve in the coming years and they point to promising findings in stem cell therapy and epigenetics, the study of how environmental factors interact with genes, respectively.

“The health of newborns today will be reflected in the health of society as a whole a few decades from now,” says Fusch, emphasizing the need for increased funding of research, medication and technology related to neonatal care. “The healthier we are as newborns, the healthier we are as adults.”