Since the XIX century, Medicine has been interested in sick, particularly premature, newborn babies. First incubators and gavage feeding techniques where used by then.

In the second half of the XX century, with technological development, several practices will become available like invasive and non-invasive ventilation, monitoring devices, parenteral nutrition, prenatal corticosteroids and exogenous surfactant, ultrasonography, inhaled oxide nitric, induced hypothermia and ECMO. These advances will allow the survival, globally with less impairment, of a much greater number of newborn babies. These facts are well documented by the evolution of perinatal and neonatal mortality rates in developed countries.

“Neonatology” is first used in 1960.

In Portugal, as well, since the beginning of the 70s (at Santa Maria Hospital in 1973) are made available “nurseries”, “premature wards” and delivery room paediatric attendance. “Basic Perinatal Care” is structured at national level for public hospitals in the late 70s.

The first ventilator to be used in this hospital was a Loosco® (from Anaesthesiology), in 1976, by Dr Ofélia Guerreiro. The first premature baby survived after being ventilated in 1977. Since then, and until 1983, ten babies survived ventilation. Newborn-type ventilators (BearCub® BP 200 e BP 2001) where then acquired. Medical neonatal staff is available since 1986, even if a specific graduation in this area was only recognised, first within medical public career, in the 90s and afterwards by Portuguese Medical Board. The sub-speciality was recognised in 2003. Since the 90s there will be a progression of increasingly more sophisticated ventilators such as synchronized, volume-guaranteed and high-frequency types and the highly important non-invasive ventilation.

The organization of perinatal care, proper equipment acquisition and staffing, along with the implementation of a specific newborn transport system in the late 80s where a major advance for the improvement of newborn care in Portugal. Our results did match the best.
We received at Santa Maria Hospital the coordination of the newborn transport system in Lisbon, in 1987 (Dr Lincoln Silva). It was transferred latter to Alfredo da Costa Maternity Hospital.

As long as this technological development occurred, the importance of individualized care was also being recognised, and comfort care, family support and all the psychological and social aspects are dealt with to enhance child development. The neonatal team will include now psychologists, nutritionists, physical therapists and social service staff beyond multidisciplinary medical paediatric and non-paediatric areas. We are a neonatal reference centre for surgery, neurosurgery, metabolic, neurological and kidney diseases.

Far beyond intensive care, we welcome the birth of normal newborns. In this field we emphasize screening procedures, prevention of disease and accidents and promotion of health in its utmost sense. We are preparing ourselves to become a UNICEF “baby friendly hospital”, thereby confirming our total support of breastfeeding as a major health benefit.

Teaching has always been important. We are involved in pre and post-graduate Paediatric training and specific neonatal post-graduate teaching. A lot of resources are used to train other health practitioners both from within and outside the hospital.
Margarida Ejarque Albuquerque
guida.ejarque@gmail.com

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Bibliography:

Cardoso B, Oliveira G, Albuquerque, ME. Ventilação Assistida na UCERN desde 2000.
Sessão clínica do serviço de pediatria do HSM. 2008. np
Guerreiro, O. Unidade de Neonatologia do HSM 1973-2005. Apontamentos.
Jornadas de Neonatologia do HSM. 2005. np
Videira Amaral, JM. A Neonatologia no Mundo e em Portugal. Factos Históricos.
Angelini, 2004