When I was in high school, history was my least favorite subject. Memorizing dates, names of rulers, czars and leaders, battles and historic events held no interest. However, several years ago, I was fortunate enough to make a trip to Paris and Germany. The experience brought history to life and kindled an interest. Reading about where real life experiences take place and seeing where they actually happened made it more interesting, even, in some cases, talking to people who were a part of it. Thus, bringing life to history….and, there is much to be learned.
Having said that, neonatology is rich with history that should not be lost. Some of it is just entertaining and some is important as we move forward in our learning. The first real invention that changed the face of infant care was the incubator.1 The incubator invention is attributed to a French physician who was inspired by seeing chicks in their warming incubators at the zoo! This happened in the late 1800’s, probably around 1880. This led to another, more significant change. Up until this time, most babies were delivered at home and, if premature, cared for by their mothers. Once this “medical technology” was available, there seemed to be a reason to bring these babies to the hospital for additional care. This led to a battle, of sorts between obstetricians, who first provided care to these infants, and mothers who saw themselves as the best prepared to care for their own babies. As time progressed, the care of these babies became the responsibility of pediatricians and finally, neonatologists when that field was born (no pun intended!). At around the same time as the invention of the incubator, various nursing care procedures were perfected or adapted for care of the neonate. One that came about around the same time as the incubator was gavage feeding. The focus on newborn care and the incubator, improved feeding techniques and perhaps other care measures resulted in a drop in infant mortality from 66% to 38%.1
Many inventions progressed over the next several years but very slowly and none really changed the face of newborn care until the invention of the modern mechanical ventilator. Ventilators were used in the 18th century but it was quickly discovered that they led to pneumothoraces. Therefore, they were not used much and the popular mode of ventilation, particularly in neonates, was non-invasive. Finally, around the time of the polio epidemic, ventilators were somewhat perfected for adults. In the 1970’s these adult ventilators were adapted for use in neonates with a variety of consequences, particularly chronic lung disease and pneumothoraces. Late in the 1970’s, ventilators were available specifically to meet the needs of the neonatal lung. Many advances have been made in neonatal ventilators since then! Then, the invention of surfactant changed neonatal pulmonary management drastically as well. Meanwhile, a lot was being learned about use of oxygen in the newborn. I worked with a neonatal nurse early in my career who shared her experience in the early days of neonatal care. The NICU was not yet a specific unit in the hospital. Rather, these babies were placed in a room off the newborn nursery. She said the oxygen was turned on, often at a relatively low level of 30-40% but sometimes much higher, and the infant was left alone. It was felt it was better if no one stimulated the infant, including parents who were only allowed to look from the window or door. So, it was just a watch and wait attitude to see how the infant would progress.
This brings me to the progress in developmental care. How much we have learned in this arena! And yet, still have much to learn and apply. From the early days when mothers were removed from the care of their infants to lessons we have learned that mothers (and fathers) are the constants in the infant’s life. Yet, since neonatal care is such a high technology field, the simpler things are often discounted. Today, there are lots of changes continuing in neonatal care. Some are quite simplistic and may be discounted as being unimportant. There have historically been many seemingly insignificant changes that have led to monumental changes in outcome. Things as simple as handwashing and maintaining body temperature have led to significant changes in infant mortality and improved morbidity. As we move forward in refining the care we provide to neonates, there is still lots to be learned and embraced by those on the front line.
1. Baker JP. The incubator and the medical discovery of the premature infant. Journal of Perinatology. 2000; 5:321-328.
2. Chernick V, Mellins RB. Pediatric pulmonology: A developmental history in North America. Pediatric Research. 2004; 55:514-520.