Neonatal pediatrics has made an outstanding and unprecedented progress in recent years. During 70 years of last century, the guiding principles of newborn care were “masterly inactivity” with a quiet and gentle hands-off approach (<xref ref-type="bibr" rid="bib001">1</xref>). In the last 30 years, technology has revolutionized neonatology and we have moved from an exceedingly passive to an extremely aggressive mechanistic approach (<xref ref-type="bibr" rid="bib002">2</xref>,<xref ref-type="bibr" rid="bib003">3</xref>). There is no doubt neonatology has provided an identity or status to pediatrics but where are we heading? Are we trying to save “previable” babies and going against nature? Are we converting deaths into disability? We must modify our aggressive approach and enthusiasm with common sense and keep social constraints and existent realities in mind. We must exercise restraint and keep a check and balance on the pace of change in order to prevent “disasters of our good intents” or iatrogenic disorders (<xref ref-type="bibr" rid="bib004">4</xref>,<xref ref-type="bibr" rid="bib005">5</xref>). The knowledge must be transformed into wisdom and must be used with social concerns and existent realities. We must pursue a balanced middle path in life for best dividends – it should neither be too passive nor too aggressive. There is a need that “evidence based” neonatology should be integrated with individual experience, expertise and common sense to adopt rational and best practices for care of newborn babies (<xref ref-type="bibr" rid="bib006">6</xref>).There is certainly a need to develop specialized newborn care facilities in a phased manner at different health care levels throughout the country. But we should not allow technology to dehumanize medicine. We must treat the babies not only with our brain but also with our heart. The special care baby units and NICUs should provide womb-like ecology – comfort, warmth, protection from strong light, loud sounds and microbes, soothing music akin to uterine blood flow – and continue transmaternal feeding by promotion of breast feeding and feeding with expressed breast milk to all babies. Mother should not be isolated or severed from her baby after birth but encouraged to touch and talk with her baby in the NICU. She should be guided to provide intermittent short-term skin-to-skin contact to provide warmth and comfort to the baby and hopefully transmit tremendous electromagnetic energy from a compassionate and concerned mother to her baby to augment the process of healing (<xref ref-type="bibr" rid="bib007">7</xref>). We must demystify NICU and promote bonding of the baby with his family. We should not try to satisfy our ego by trying to save “previable premies” and our aim should not be merely to ensure survival but an “intact” survival so that baby grows to become an asset to the nation rather than a liability to the society.However, it is important to remember that NICUs cannot reduce national infant mortality rate. They are cost-intensive and they do compromise social justice by providing care to those who can afford. The community should invest in social interventions to reduce the incidence of low birth weight, IUGR and premature babies. Maternal health and nutrition are intimately linked with health, wellbeing and survival of their babies. Mothers are the creators of progeny and unless they are provided with health care, optimal nutrition, education and dignity without any discrimination throughout their life-cycle i.e. infancy, childhood, adolescence, pregnancy and lactation; it is not possible to improve health and wellbeing of our children. Birth weight is the most important correlate of survival of a newborn baby and it depends more upon the health and nutrition of the mother (rather than the father!) because she is both the seed as well as the soil in which the baby is nurtured for nine months (<xref ref-type="bibr" rid="bib008">8</xref>).In the 21st century, we must sever our dependence on <italic>dais</italic> and develop necessary infrastructure under the aegis of RCH II Program so that every pregnant woman is provided with essential antenatal care and every delivery takes place in a health care facility and is conducted by health care workers who are specially trained to conduct deliveries and look after the newborn babies. As an interim measure, the model of community newborn care developed by Abhay Bang and his colleagues at Gadchiroli need to be adapted and universalized throughout the country (<xref ref-type="bibr" rid="bib009">9</xref>). In the long run, the country should create a “Kerala culture” to enhance literacy to 100%, empower women and provide health care facilities at the door steps to achieve the national health targets of 2010. Newborn care needs a mission approach and we must promote it and nurture it by a strong political will as people's movement. Neonates do constitute the foundation of a nation while mothers are its pillars and no sensible government can afford to neglect their needs and rights.</sec></body><back><ref-list><title>References

JNNFI

Journal of Neonatology

0973-21870973-2179

National Neonatology Forum

jn-20-3-007

Commentaries

Neonatology at the crossroads

Singh

Meharban

Former President

National Neonatology Forum of India and Indian Academy of Pediatrics. E-mail: meharban.s.singh@gsk.com

7–92006

203254255

Neonatal pediatrics has made an outstanding and unprecedented progress in recent years. During 70 years of last century, the guiding principles of newborn care were “masterly inactivity” with a quiet and gentle hands-off approach (<xref ref-type="bibr" rid="bib001">1</xref>). In the last 30 years, technology has revolutionized neonatology and we have moved from an exceedingly passive to an extremely aggressive mechanistic approach (<xref ref-type="bibr" rid="bib002">2</xref>,<xref ref-type="bibr" rid="bib003">3</xref>). There is no doubt neonatology has provided an identity or status to pediatrics but where are we heading? Are we trying to save “previable” babies and going against nature? Are we converting deaths into disability? We must modify our aggressive approach and enthusiasm with common sense and keep social constraints and existent realities in mind. We must exercise restraint and keep a check and balance on the pace of change in order to prevent “disasters of our good intents” or iatrogenic disorders (<xref ref-type="bibr" rid="bib004">4</xref>,<xref ref-type="bibr" rid="bib005">5</xref>). The knowledge must be transformed into wisdom and must be used with social concerns and existent realities. We must pursue a balanced middle path in life for best dividends – it should neither be too passive nor too aggressive. There is a need that “evidence based” neonatology should be integrated with individual experience, expertise and common sense to adopt rational and best practices for care of newborn babies (<xref ref-type="bibr" rid="bib006">6</xref>).There is certainly a need to develop specialized newborn care facilities in a phased manner at different health care levels throughout the country. But we should not allow technology to dehumanize medicine. We must treat the babies not only with our brain but also with our heart. The special care baby units and NICUs should provide womb-like ecology – comfort, warmth, protection from strong light, loud sounds and microbes, soothing music akin to uterine blood flow – and continue transmaternal feeding by promotion of breast feeding and feeding with expressed breast milk to all babies. Mother should not be isolated or severed from her baby after birth but encouraged to touch and talk with her baby in the NICU. She should be guided to provide intermittent short-term skin-to-skin contact to provide warmth and comfort to the baby and hopefully transmit tremendous electromagnetic energy from a compassionate and concerned mother to her baby to augment the process of healing (<xref ref-type="bibr" rid="bib007">7</xref>). We must demystify NICU and promote bonding of the baby with his family. We should not try to satisfy our ego by trying to save “previable premies” and our aim should not be merely to ensure survival but an “intact” survival so that baby grows to become an asset to the nation rather than a liability to the society.However, it is important to remember that NICUs cannot reduce national infant mortality rate. They are cost-intensive and they do compromise social justice by providing care to those who can afford. The community should invest in social interventions to reduce the incidence of low birth weight, IUGR and premature babies. Maternal health and nutrition are intimately linked with health, wellbeing and survival of their babies. Mothers are the creators of progeny and unless they are provided with health care, optimal nutrition, education and dignity without any discrimination throughout their life-cycle i.e. infancy, childhood, adolescence, pregnancy and lactation; it is not possible to improve health and wellbeing of our children. Birth weight is the most important correlate of survival of a newborn baby and it depends more upon the health and nutrition of the mother (rather than the father!) because she is both the seed as well as the soil in which the baby is nurtured for nine months (<xref ref-type="bibr" rid="bib008">8</xref>).In the 21st century, we must sever our dependence on <italic>dais</italic> and develop necessary infrastructure under the aegis of RCH II Program so that every pregnant woman is provided with essential antenatal care and every delivery takes place in a health care facility and is conducted by health care workers who are specially trained to conduct deliveries and look after the newborn babies. As an interim measure, the model of community newborn care developed by Abhay Bang and his colleagues at Gadchiroli need to be adapted and universalized throughout the country (<xref ref-type="bibr" rid="bib009">9</xref>). In the long run, the country should create a “Kerala culture” to enhance literacy to 100%, empower women and provide health care facilities at the door steps to achieve the national health targets of 2010. Newborn care needs a mission approach and we must promote it and nurture it by a strong political will as people's movement. Neonates do constitute the foundation of a nation while mothers are its pillars and no sensible government can afford to neglect their needs and rights.</sec></body><back><ref-list><title>References1Robertson

. Reflections on errors in neonatology: I The “hands off” years 1920 to 1950. J Perinatol, 2003; 23: 48–55.2Robertson

. Reflections on errors in neonatology: II The “heroic” years 1950 to 1970. J Perinatol, 2003; 23: 154–161.3Robertson

. Reflections on errors in neonatology: III The “experienced” years 1970 to 2000. J Perinatol, 2003; 23: 240–249.4Philip

AGS

. The evolution of neonatology. Pediatr Res, 2005; 58: 799–815.5Silverman

. Neonatal pediatrics at the century mark. Perspect Biol Med, 1989; 32: 159–170.6Ambalavanan

Whyte

. The mismatch between evidence and practice. Common therapies in search of evidence. Clin Perinatol, 2003, 30: 305–331.7Singh

Deorari

. Humanized care of preterm babies. Indian Pediatr, 2003; 40: 13–20.8Singh

. Intrauterine growth retardation. In: Care of the Newborn. Sagar Publications6^th edition 2004, p 230.9Bang

Bang

Reddy

Deshmukh

Baitule

. Reduced incidence of neonatal morbidities: Effect of home-based neonatal care in rural Gadchiroli India. J Perinatol, 2005; 25: S51–S61.