Foreward

Article Outline

• Copyright

This two-topic issue reflects how very far we have come in newborn medicine in the last half-century. In 1952, Virginia Apgar (an anesthesiologist and the first woman full professor at Columbia University College of Physicians and Surgeons) invented the Apgar score. This score allowed, for the first time, consistent measurement of the status of a newborn baby immediately after birth. Although the Apgar score is not a particularly good predictor of neonatal asphyxia, her work began an important investigation into how best to manage babies who are compromised at the time of birth. In this issue of CPPAH, Haider and Bhutta describe the current state of knowledge of this condition, which is far more common in developing countries than in industrialized countries, but remains a problem everywhere. The research needs in this area must focus not only on management of the baby, but also on the potential for changes in maternal care to help prevent this potentially devastating problem.

Of course, getting past the delivery in good shape doesn’t mean all is well for the baby. Every general pediatrician remembers at least one case of overwhelming neonatal sepsis in a baby who appeared completely normal only hours before. And infection is one of the scourges of the NICU—just when a tiny preemie seems to be doing well, a sudden downturn occurs, and it’s back to the “sepsis work-up,” with fears of resistant organisms and fungal sepsis. Why is this? For instant insight, take a look at the table on page 198. Newborn babies just don’t quite “have it” yet when it comes to immunity. In the second half of this issue, Richard Stiehm and colleagues discuss the rich and rapidly changing field of neonatal immunology. Many of the terms used to describe the state-of-the-art in this field were not even invented when Dr. Apgar invented the Apgar score! (“Chemotaxis” entered MeSH in 1970, “cytokine” entered in 1991). These two articles will bring readers up to date in important areas of pediatrics, relevant not just to neonatologists but to all pediatricians.