Care of the Newly Born Needs to Begin Prior to Birth and to Continue then After

Abstract

Care of the Newly Born Needs to Begin Prior to Birth and to Continue then AfterRecent scientific progress has brought increasing clarity in our understanding of the etiopathogenesis, diagnosis, and the optimal management of many structural abnormalities and diseases that we see in newborn infants. 1 Many of these abnormalities have a prenatal onset and can now even be monitored in utero for progression and complications. 2,3 In these efforts, advanced imaging and analysis of fetal DNA in fetal/maternal blood has facilitated diagnosis, grading of severity, and, in many conditions, helped define indications for temporizing or definitive treatment prior to birth. [4][5][6][7] Such progress has been possible most notably in genetic, neurological, hepatobiliary, and hematological problems. 6 Initiation of care before such disorders get established and/or the onset of secondary complications can possibly make a difference. 8 In many conditions, there is now encouraging evidence for effectiveness of specific management performed in utero on immediate and medium/long-term outcomes. 9 Early diagnosis is a key determinant of outcomes in most neonatal conditions. 10 The timing of disease onset may be particularly important because of the possibility of interruption in the structural and functional changes that are going on during that period of development. 3 Hence, serial imaging and/or laboratory tests can be used not only for monitoring fetuses/infants with known disease conditions but also for the evaluation of normal or hitherto asymptomatic fetuses/infants who have known familial or genetic risk factors. 3 Knowledge about the severity and extent of various abnormalities/diseases can help prepare for treatment procedures and counseling the families. 11 Most of these procedures are complex and need a multi-disciplinary approach for optimizing the outcomes. 12 The importance of preparing a closely knitted team and establishing a close relationship with the families is important as the possibility of adverse outcomes and even reproductive grief cannot be overlooked. 13 Transparency is a key word in this process. A paternalistic physician attitude is not acceptable; evidence-based, collaborative approaches are more appropriate for families and care-providers handling adverse outcomes. 7 In the Newborn, our aim is to cover problems that a baby might develop in utero, the perinatal period, following birth, and the implications of these abnormalities during the first 1000 days after birth. In this 2 nd issue of our journal, we present a set of articles that represent each of these subsets. The risk of perinatal mortality is a matter of universal concern. Shukla and Carlo 14 have reviewed the predictive accuracy of machine-learning statistical models for intrapartum stillbirth and neonatal mortality. Another article summarizes the information we have on the association between chromosomal abnormalities and neonatal necrotizing enterocolitis (NEC); the authors noted a possible association with abnormalities in chromosomes 1, 6,...