Neonatal intensive care and the prevention of major handicap.

During the past 20 years there has been a great increase in the understanding of deranged physiological mechanisms in certain groups of newborn infants that were, in the past, at high risk for death or major handicap. Much information of direct clinical relevance has come from the study of experimental animals, particularly about the changes that occur in the lungs and circulation at birth. Work in progress on an animal model of intraventricular haemorrhage suggests that this, like many other causes of brain damage, is a potentially preventable condition. Technological advances, such as continuous blood-gas analysis, make the prevention of handicapping conditions simpler, but the application of modern methods can be expensive. Current evidence shows that neonatal intensive care saves lives, and that the incidence of major handicap in the survivors is reduced. Society will have to decide how much money should be put into this area of medicine, and it will also have to help neonatal paediatricians with the difficult ethical dilemmas that they are now having to face.