Atlas of Procedures in Neonatology – Fifth Edition
ATLAS OF PROCEDURES IN NEONATOLOGY FIFTH EDITION
Neonatology is a taxing ﬁeld: strenuous, demanding, confusing, heartbreaking, rewarding, stimulating, scientiﬁc, personal, philosophical, cooperative, logical, illogical, and always changing.” From the preface to the ﬁrst edition of the Atlas of Procedures in Neonatology, 1983.
The preface to the ﬁrst edition of the Atlas of Procedures in Neonatology was written approximately 8 years after the ﬁrst sub-board examination in Neonatal-Perinatal Medicine was held in the United States. In the preface, emphasis was placed upon the rapid development of new technology and the decreasing size (<1.5 k) and maturity (<32 weeks’ gestation) of the patients in the neonatal intensive care unit. Thirty years later, patient size (≈400 g) and maturity (≈22 to 23 weeks’ gestation) are at a nadir, having reached the current limits of newborn viability. Thus, over the years, our patients have become increasingly fragile and challenged to withstand the stress of living with extremely immature organs plus the additional stress and trauma associated with the very therapy required to keep them alive. New therapies and technologies continue to develop (e.g., Brain and Whole Body Cooling, new Chapter 45), “old” therapies have been re-established for use in very premature infants (e.g., Bubble Nasal Continuous Positive Airway Pressure, new Chapter 35). Since the landmark report of the Institute of Medicine, “To Err is Human,” was published in 1999, the paradigm of medical care has been focused on patient safety, and nowhere is it more important than in the neonatal intensive care unit. Errors in this vulnerable patient population can have devastating, damaging, and serious immediate and long-term consequences. Teamwork and the use of evidence-based guidelines have had a signiﬁcant impact on some complications of intensive care, such as catheter-related bloodstream infections, which were previously thought to be inevitable. However, we noted as we prepared this edition, some previously unreported complications of long-established procedures, and numerous isolated case reports of “unusual complications,” making them not uncommon at all. Such reports serve to emphasize that the neonatologist must remain vigilant, and not only continuously monitor the impact of the technologic and other advances speciﬁc to their own ﬁeld, but also the impact of advances in the other specialties that contribute to neonatal intensive care. In this edition, we have replaced the procedures DVD with a Website. Contents include fully searchable text, an image bank, and videos. To the video collection, we have added lumbar puncture, radial artery puncture, intraosseous infusion, bubble CPAP, and pericardiocentesis, continuing the tradition established with the fourth edition to include both commonly performed procedures and vital emergency procedures that trainees may have infrequent opportunity to perform. In the 1980s, procedures performed on neonates were practiced on animals and homemade simulators. In 2012, simulators include sophisticated, interactive model humans, capable of testing not only practical skills but also the reasoning process involved in making good therapeutic decisions (see Educational Principles of Simulation-Based Procedural Training, new Chapter 1). No simulation equipment can currently replicate the fragility of the extremely preterm infant, but this will undoubtedly change over the next few years. We recognize that, in order to decrease risk and improve patient safety, the crucial element in simulated training is not so much the expensive and technologically advanced model as the opportunity to practice critical skills repeatedly in a safe environment, with precise measurements of performance and constructive feedback. The above quote from the ﬁrst edition of theAtlas of Procedures in Neonatologyremains as pertinent today, for the ﬁfth edition, as it was 30 years ago. Mhairi G. MacDonald, MBChB, DCH, FAAP, FRCPE, FRCPCH Jayashree Ramasethu, MBBS, DCH, MD, FAAP Khodayar Rais-Bahrami, MD, FAAP