History of the BAPM

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Development of BAPM

Although in 1972 the British Paediatric Association (BPA) publication Paediatrics in the 70s advised that the time had come to recognise perinatal paediatrics as a sub-speciality in its own right, progress was at first slow. The Neonatal Society, founded in 1959 with a membership from many disciplines, already provided an academic forum for scientific presentations. When approached by the BPA in 1975, this Society declined to take on an advisory role. That year Dr Peter Dunn had undertaken, at the request of the BPA and the DHSS (Department of Health and Social Security), a survey of those paediatricians who were working mainly with newborn babies in maternity hospitals. Twenty doctors in the British Isles, including Ireland, were identified as working 60% or more of their time with the newborn. With the approval of the BPA they were invited to discuss the formation of a new perinatal group. After the preliminary discussion in York in 1976, a formal meeting took place in Bristol on the 26th of November and the British Paediatric Perinatal Group (BPPG) was founded with the primary objective of improving the standard of perinatal care in the British Isles.

The founding members formed themselves into a Committee with an Honorary Secretary and Honorary Treasurer. Membership was open to all British and Irish paediatricians and others having a professional interest in the unborn and newborn baby. Affiliation with the BPA, now the Royal College of Paediatrics and Child Health (RCPCH), was established early in 1977 with agreement that the Honorary Secretary of the BPPG should also act as Perinatal Convener to the College. It was agreed too that the two bodies should jointly determine the paediatric representation to the Joint Standing Committee of the BPA and the RCOG (Royal College of Obstetricians and Gynaecologists). The RCOG also agreed to ensure that at least one of their representatives of the Joint Committee was also a member of the BPPG.

By 1980 the work and membership of the BPPG had increased so much that it became necessary to create the Office of Chairman and an Executive Committee representing England and Wales, Scotland and Ireland. In 1981 the name of the group was changed to the British Association for Perinatal Paediatrics and was registered as a charity. At the same time the name of the Committee was changed to Council and the Office of Chairman to President. In 1985, with a marked increase in obstetric membership, it was felt appropriate to change the title once more to the British Association of Perinatal Medicine (BAPM).

In 1991 it was agreed to widen the membership and to replace the annual Council Meeting with an Annual General Meeting open to all members. Over the years the size of the Association has steadily expanded as new neonatal paediatricians have been appointed and as obstetricians and others interested in the perinatal period have joined the Association and contributed to the useful all-day debates held each year at the AGM. Among other disciplines and professional bodies now represented at the AGM are the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Neonatal Nurses Association, the Perinatal Pathology Group, the British Association of Paediatric Surgeons, the Royal College of General Practitioners and the Royal College of Anaesthetists, as well as the National Perinatal Epidemiology Unit and the Department of Health.

Undoubtedly the most important achievement of the BAPM was to obtain formal recognition of the new sub-specialty from the Royal Colleges of Physicians and the BPA. This was not easy but after several years of representations, a Specialist Advisory Committee (Paediatrics) Training Programme was agreed in 1982 for those doctors seeking dual accreditation in Paediatrics and Perinatal Paediatrics. The BAPM, at the SAC's request, also advised on guidelines for the recognition of hospital training posts suitable for those seeking such accreditation. Since 1997 the RCPCH has assumed responsibility for organising training in paediatric medicine and the BAPM has been invited to nominate Specialty Training Advisers and members for the new College Specialist Advisory Committee in Neonatal Medicine. More than ever the BAPM is closely involved in syllabus-setting and accrediting training posts for the neonatal specialists of the future.

A second BAPM objective has been to improve the facilities for perinatal care. This aim has been prosecuted through national surveys on perinatal medical and nurse staffing, on the facilities for care of the newborn and in particular on the availability of intensive care cots, through advice to the DHSS and other national bodies, and through published recommendations such as:

  • the joint BPA/BAPM Statement on Categories of Babies Receiving Neonatal Care (1985)
  • Standards for Hospitals Providing Neonatal Intensive Care (1996)
  • the BAPM Dataset (1997)
  • Fetuses and Newborn Infants at the Threshold of Viability: A Framework for Practice (BAPM 1999)
  • Standards for Hospitals Providing Neonatal Intensive and High Dependency Care (Second Edition) and Categories of Babies requiring Neonatal Care (December 2001).

The Association has furthered postgraduate education in perinatal medicine by holding annual national symposia which, commencing in Bristol in 1976, have moved to different centres in the British Isles each year. Joint Scientific Meetings have also been held annually in association with the BPA, and RCPCH and with the RCOG (1984-85, 1986), the Neonatal Society (1985), the Neonatal Nurses Association (1987; 1998), the Blair Bell Society (1988), the Nutrition Society (1992), the Paediatric Research Society (1989 and 1993), the Irish Perinatal Society (1994), the European Association of Perinatal Medicine (1996) and the Obstetric Anaesthetists Association (2001). Since 1982 these annual perinatal symposia have been enriched by the endowment of a Founder's Lecture, given each year by a doctor or scientist who has made a distinguished contribution to perinatal care in the British Isles. In 1990 the endowment was increased to permit the Association to invite an Overseas Founder's Lecturer every third year or so. The first such lecture was given in 1991 by Professor Robert Usher of Montreal and the second by Professor Jeffrey Robinson of Adelaide in 1996.

A further aim of the Association has been to catalyse and organise multicentre research. Several projects have been successfully supported including studies on Vitamin K therapy, the incidence of neonatal herpes simplex, the epidemiology of necrotising enterocolitis, the use of ethamsylate, Vitamin E and exogenous surfactant in the management of the preterm infant, and the impact that in vitro fertilisation and GIFT is having on the incidence of multiple pregnancy and the need for intensive care. In addition, the Association has published Guidelines on the Management of RDS, on the Use of Exogenous Surfactant and on the Management of Retinopathy of Prematurity (jointly with the RCOphth). In 1992 the Association established a Clinical Trials Group. Currently this Group advertises and facilitates multicentre trials and convenes a successful annual meeting to discuss forthcoming trials and issues relating to perinatal research.

In years since 1976, perinatal mortality in the UK has been cut by more than half. About 8000 babies that used to die each year now survive. Still, there are no grounds for complacency. Babies still die unnecessarily, while others survive with disabilities, which might have been prevented with better care and facilities. Whilst progress has been made, there remain many challenges for the years ahead, and in particular for the many babies that now return home within a few hours of birth.