Daved van Stralen, MD, FAAP, Thomas A. Mercer, RAdm, USN 

Abstract 

Neonatology began with the extension of care to smaller babies born earlier in gestation and now extending into the threat of COVID-19. Extending operations into a new environment places everyone in novel situations. Emerging from actual operations within dangerous contexts, HRO extends operations and the organization into uncertain, adverse, and hostile environments. The physical actions of care come from motor cognition, the influence of the cerebellum and motor cortex on cognition, and how we learn through physical action to understand events. Rather than study the myriad ways a system can fail or how it can reach the final common pathway of failing, we can study and respond to it as a liminal zone. It is common to all failures – an exigency of ambiguous information, impending proximal threat, uncertainty, and demand for action. Engagement in the liminal zone is the same as engagement for extension, drawing from four domains: categorization, methods of decision making, the significance of the affective processes, and modulation of stress and fear responses. Perhaps the purpose of safety, reliability, and resilience is not to safely work in a dangerous context but to support the extension of the organization into uncertainty, a new environment, unpredictable circumstances, or to penetrate threats. When a person believes in themselves, they will leave their place of safety and engage the unknown when they know they are supported. This is the extension of neonatology. 

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