Contributors ix

Lamia Soghier, MD, FAAP

Assistant Professor of Pediatrics

The George Washington University School of Medicine and the

Health Sciences

Attending Physician

Division of Neonatology

Department of Pediatrics

Children’s National Medical Center

Washington, DC

Martha C. Sola-Visner, MD

Assistant Professor of Pediatrics

Children’s Hospital Boston

Harvard Medical School

Boston, Massachusetts

Ganesh Srinivasan, MD, DM, FAAP

Assistant Professor Pediatrics and Child Health (Neonatology)

Director, Neonatal–Perinatal Fellowship Program

University of Manitoba

Researcher

Manitoba Institute of Child Health

Winnipeg, Manitoba, Canada

Keith Thatch, MD

Pediatric Surgery Intensivist

Clinical Lecturer

University of Michigan Health System

Ann Arbor, Michigan

Marianne Thoresen, MD, PhD

Professor of Neonatal Neuroscience

School of Clinical Sciences

University of Bristol

Bristol, United Kingdom

Professor of Physiology

Institute of Basic Medical Sciences

University of Oslo

Oslo, Norway

Gloria B. Valencia, MD

Division Chief NICU Director

Department of Pediatrics

Neonatology and Perinatal Medicine

SUNY Downstate Medical Center

Brooklyn, New York

S. Lee Woods, MD, PhD

Medical Director

Center for Maternal and Child Health

Maryland State Department of Health and Mental Hygiene

Baltimore, Maryland

x

Preface

“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 the Atlas of

Procedures in Neonatology remains 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