Noboru Kobayashi, neonatology, perinatal, perinatal medicine
The 48th Annual Congress of Japan Society of Perinatal and Neonatal Medicine (JSPNM) was held from July 8 to 10 in Omiya on the subject of "Collaboration to Support the Hopes of All Mothers and Infants--From the Family to International Cooperation." The chair of the Congress is Dr. Masanori Tamura, Professor of Pediatrics, Saitama Medical Center, Saitama Medical University. When I headed the Department of Pediatrics at the University of Tokyo, Dr. Tamura studied medicine at the University of Tokyo, and after graduation, completed his residency in pediatric medicine there. He is now active internationally as a leading figure in the field. I was both humbled and honored to be invited to take part in this Congress.
I would like to devote this month's column to the subject of perinatal medicine, which may be one that you are not familiar with. The above Congress was the 48th and the society was founded forty-eight years ago. If my memory serves me correctly, the Japan Society of Neonatal Medicine was established first, and then the Japan Society of Perinatal Medicine, and the two societies merged about ten years ago. Their names were then combined as written above.
As we can see by its name, the Society of Neonatal Medicine researches the field of medicine and medical treatment of neonates or newborns while the Society of Perinatal Medicine undertakes medical research on issues that affect mother and child during the period before and after birth. Simply put, medicine seeks the cause of an illness, while medical treatment includes a wide range of practical techniques based on medicine that is suitable for the patient's condition. Neonatal medicine is included in perinatal medicine, and in fact, constitutes an important part of it. Needless to say, insofar as the primary role of medicine and medical treatment is to save lives, saving the life of the mother, not only infant, is a major objective.
Perinatal medicine in Japan, in particular, neonatal medicine, is advanced and has received much attention internationally. Fortunately, compared with the rest of the world, Japan has the lowest neonatal mortality rate (mortality rate of infants under four weeks), infant mortality rate (under one year) and perinatal mortality rate (early neonatal mortality rate under one week + fetal mortality rate after 28 weeks of gestation). In 1999, the figures were a low 3 deaths per total 1,000 births: 1.2 for neonates within one week of birth, 0.5 for infants between one week and one month (four weeks) of birth, and 1.3 for infants between one month and one year of birth. In other words, the infant mortality rate in Japan within one year of birth is only 3 per total 1,000 births, far lower than 7.1 in the United States and 5.9 in the United Kingdom. On the other hand, the number of maternal deaths per 100,000 births (maternal mortality rate) in Japan was 7.3 in 2002, unfortunately higher than in Canada, the United States, and Germany. The infant mortality rate in Singapore, which has recently improved, now closely follows that of Japan and is, in fact, lower in some years.
Medical treatment for neonates involves not only pediatricians, but also midwives and nurses, while perinatal medicine also involves obstetricians. As such, the above statistics are the result of teamwork by all these medical practitioners, that is, they are produced by perinatal medicine as an interdisciplinary field of medicine and medical treatment. In the medical treatment of neonates, especially premature infants, engineers and other specialists also play an important role in the development and operation of equipment to maintain body temperature and control respiration. However, there are various causes of maternal mortality, including hemorrhaging, and the reason for the high mortality rate is not been clarified.
Professor Tamura, an internationally renowned expert on respiratory care, or resuscitation, of neonates and premature infants, has devoted himself to the research and development of better respiratory care and resuscitative technology. As a result, it was a major concern of this Congress and was included in many of the programs. As for other programs, the keynote address by Dr. K.J.S. Anand, University of Tennessee, on "Management of Pain in the Neonate: Current Practice and Novel Options" drew much interest. In the past, it was believed that infants did not need anesthesia on the grounds that they were not very sensitive to pain. We now know, however, that the fetus and neonate do feel pain and that anesthetic techniques must be adjusted accordingly.
The specialists in perinatal and neonatal medicine and treatment come from a wide range of fields, and over 2,500 people attended this Congress. The program included topics that were not directly related to medicine. In his keynote address titled "Hug All Children Now with Lots of Love," non-fiction writer, Yanagida Kunio, talked about showing love for children, ranging from stories of children in the Great East Japan Earthquake to children's picture books, and other subjects for those in the audience who deal with perinatal medicine. No doubt, the audience found it moving and learned a lot from it. Dr. Tamura, who served as chair, most certainly invited Mr. Yanagida because of his gentle way of looking at children. I was invited to two social gatherings and enjoyed meeting old friends and colleagues.
Perinatal medicine and treatment are concerned with the site of birth and where the mother-child relationship is forged, which also makes it an important field in the formation of the family and home and functioning of society. Although Japan is in the forefront of perinatal medicine and treatment internationally, there is still much that needs to be improved, such as the maternal mortality rate. We also have the great responsibility of aiding developing countries in their perinatal medicine and treatment. Attending the Congress chaired by Dr. Tamura, I felt the strong desire to see more young people enter the field of medicine and study perinatal medicine and treatment.
- Group for Public Education of Mother-Child and Family Health [Boshi hoken katei hoken kyoiku fukyu gurupu]. Public Health for Mothers and Children in Japan [Wagakuni no boshi hoken], 2004.
- Agency for Mother and Child Health [Boshi hoken jigyodan]. Major Statistics on Mother-Child Health [Boshi hoken no omonaru tokei], 2005.