The Van Deventer Lecture. 'Prematurity: the changing scene'.

Institutional medical care of newborn infants including premature 'weaklings', had its roots in Europe about 100 years ago. Unfortunately, the physician-accoucheurs who were responsible for the new development soon gave way to surgeon-gynaecologists, and for the next half century newborn infants returned to the care of the nursery nurse. The Second World War accelerated many changes. Therapeutic advances such as the development of blood transfusion, antibiotics, and the technology of infant care, coupled with an improved understanding of the physiology and pathology of the newborn, encouraged paediatricians to enter the field. At the same time, women had become more emancipated and now had improved methods of birth control. Instead of accepting large families and an 'inevitable' wastage, especially of premature infants, they wished for few children and for all of them to survive. As neonatal intensive care developed over the last two decades, the limit of viability has been steadily pushed down towards 22 weeks' gestation and 500 g birthweight. There remain the problems associated with short- and long-term neonatal morbidity among preterm infants, including the expense that this engenders and the ethics of providing or withholding intensive care in individual cases. The future holds two main challenges: protection of the preterm infant from damage during the perinatal period and, above all, the prevention of premature delivery itself.