A review of newborn medicine in America: European past and guiding ideology.

The beginnings of newborn medicine and its rapid advance in America since the early twentieth century are reviewed through presentation of ideas that have influenced the givers of care. Newly born infants attained patient status at the end of the 19th century when Budin gave them hospital charts and Ballantyne designed the blueprint for continuity of maternal-infant care. These achievements gave impetus to the task of preserving infant life. In 1915, the United States established a birth registration area permitting calculation of infant mortality rates. These rates became the guide and yardstick for measuring progress in newborn care. Since 1915 infant mortality has decreased tenfold as survival increased successively in the postnatal infant, the neonate, and recently in the premature. Pediatricians began to supervise newborn nurseries after World War I. During depression years, national efforts were expended for the premature. After World War II, pediatricians moved close to birth, assessing and treating in the delivery room. Special care and intensive care nurseries sprang up in the 1960s. In the past 25 years, improvements in ventilation and life support systems have enhanced survival of compromised and immature infants. Today, newborn medicine is spectacularly successful in lowering neonatal mortality but is beset by costs, ethics, legal concerns, and the burden of survival morbidity. Controversy such as exists today is not new to newborn medicine; it has been its constant companion throughout history.