A Brief History of Neonatology
It is a common myth that pediatrics has
always existed and that neonatology is a
spurious subspecialty that was spawned late
in its glorious history. In fact, the opposite is
true… pediatric cardiology, pediatric surgery,
pediatric hematology, even genetics … they
all got their starts from neonatology.
Phillip V. Gordon
Information in this talk has been heavily borrowed from Neonatology on the Web
Nothing happened
during the dark ages
1200s (the dark
ages are over)
Hospital for Foundlings,
Pope Innocent III (Rome)
Oldest reference to
a caesarean section
715-673 BC
(the legend of Julius
Cesar’s birth)
Soranus of Ephesus
wrote Gynecology
which included a
chapter on the care of
the newborn
98-138 AD
1630 (circa 1740)
(dawn of the age of
enlightenment)
L'Hôpital des EnfantsTrouvés, (Paris)
St Vincent DePaul & The
Daughters of Charity
agrarian society transforming into an industrial society
Large cities become the engines of industrialization
The impetus for forceps
was as much for the
evacuation of the fetus (all
too often dead) and
survival of the mother as
for improved viability
1st diagnosis of
Duodenal Atresia
1733
1st diagnosis of
Hirschsprung’s
1691
1650
The Foundling Hospital, London
(founded in 1739)
William Hogarth established the first model
of a charitable hospital for children
Le Tour d'Abandon (The Desertion Tower), Paris 1810-1860
By the 19th century foundlings have become a government
sanctioned industry (albeit a charitable and subsidized one)
1st publication of
correct average birth
weight and length
1753
(Roederer – Germany)
5 ½ lbs
Foundlings = the primary neonatal research population
Francois Chassier
recommends oxygen for
the resuscitation of
newborns (it is not utilized
for another 70 years)
1780
(today’s average birth
weight is 7 lbs)
1st description of
hypertrophic pyloric
stenosis
1788
1st description of
Transposition of
the Great Vessels
1797
Growing recognition of positive neonatal interventions
1834
(forceps deliveries)
1st description of
endotracheal
intubation for newborn
resuscitation
Blundell
1803
1802
1802
1st description of
hydrocephalus in
infants
Herberden
(Scotland)
Opening of the Hôpital des
Enfants-Malades in Paris,
(the 1st children's hospital)
1st surgical
closure of
omphalocele by
Hey
1852-1854
Great Ormond Street Hospital, London;
Children’s Hospital of Philadelphia;
and New York Nursing and Children’s
Hospital are all founded
GOSH
1847
1839
1851
First report of
gavage feedings
for infants
First use of ether
anesthesia in
obstetrics
1st description
of prune-belly
syndrome
Ground swell of big city support for children’s hospitals
CHOP
NYNCH
Jean-Louis-Paul Denucé invents the first infant incubator
1857
1901
Pan Am
Expo,
Buffalo
1904,
St Louis Fair
Late 19th century = the golden age of neonatology
1861
Late 19th century = the golden age of neonatology
WJ Little 1st
describes cerebral
1879
palsy
Sigmund Franz Crede
prescribes dilute silver
1882
nitrate for opthalmia
neonatorium
Bedeirt
(gonorrhea)
Heat treatment of
milk for 2 hrs at
100 degrees C.
for artificial
feeding (although
Louis Pasteur
invented
pasteurization 20
years earlier)
1888
Fallot
describes his famous
tetrology of congenital
heart defects
Archibald E. Garrod
postulates "inborn
errors of
metabolism" and
Heidenhain
their inheritance
1st successful repair
according to
of congenital
Mendel's Laws
diaphragmatic
1908
hernia
1902
Continuation of the golden age of neonatology
C.W. Townsend
1st description of
"hemorrhagic
disease of the
newborn“
1894
Tarnier
1st use of
oxygen (O2)
in premature
infants
1889
The father of
genetics
alkaptonuria
Ramstedt
1st successful
treatment of pyloric
stenosis with
pyloromyotomy
1912
J. B. Sidbury
1st transfusion
through the
Umbilical Vein
in Hemorrhage of
the New-Born
(Wilmington NC)
1919
Richter
1st Transthoracic
ligation of
tracheoesophageal
fistula
1913
William Ladd
(father of pediatric
surgery popularizes both
procedures in the USA)
Continuation of the golden age of neonatology
H. Dam &
W. W. Waddell
discovery of
vitamin K and
treatment of
coagulation
abnormalities
of the newborn
1936, 1937
Landsteiner & Levine
Discovery of Rh factor
Louis K. Diamond
Gregg
Established link between Rh
Congenital cataracts
isoimmunization and
due to Rubella epidemic
erythroblastosis fetalis &
Clifford
1st exchange transfusion via
1st clinical recognition of umbilical vein as treatment for
retrolental fibroplasia
erythroblastosis fetalis
1941
1942, 1946
Carl Landsteiner
Alexandar S Nadas
starts the first
pediatric cardiology
program (CHOP)
(focused on
congenital heart
disease)
1949
The father of
pediatric
hematology
Continuation of the golden age of neonatology
The father of
pediatric cardiology
Smith
Proposed
withholding
fluid in
premature
infants
1949
Patz
1st RCT to link
excessive O2 to
retinopathy of
Emerson
prematurity
Invention of
(ROP).
high-frequency
1952
oscillatory
ventilation (but
not used in
Gleiss
infants)
1953 RCT: withholding
fluid in immediate
postnatal period
not beneficial
1955
A new dark age emerges as interventions go awry
(RDS and chronic lung disease become “incurable”)
Silverman
RCT: Sulfa
drugs increase
kernicterus
1956
Sister Jean Ward
Serendipitous
observation of
effect of sunlight
on indirect
bilirubin level
1956
Introduction of
Thalidomide
1957
Joan Hodgman
Gray-Baby
Syndrome due to
use of prophylactic
Mary Ellen Avery
chloramphenicol Surfactant deficiency
1959
is the cause of
respiratory distress
1959
Mother of
phototherapy
A black cloud persist despite remarkable advances
Patrick Bouvier Kennedy
dies from RDS (34 weeks
gestation / 2100 grams)
Mildred Stahlman
pioneers mechanical
ventilation as therapy for
infant with RDS
Birth defects
linked to
thalidomide
1961
1960
A black cloud persist despite remarkable advances
1963
Now the world could
watch as infants with
RDS died not in hours,
but days, weeks…
months because of
mechanical ventilation.
The Kennedy’s
experience spurred the
Western World to find a
cure for RDS.
Victor Freda
develops Rhogam the prevalence of
erthroblastosis
starts to fall
1966
Rashkind
technique of atrial
septostomy developed
as rescue therapy for
transposition of the
great vessels
1967
Wilmore & Dudtrick
1st report of total
parenteral nutrition
for the neonate
1968
A black cloud persist despite remarkable advances
NICUs become “Chest Tube Meccas” in the 1970s
GA Gregory
invents the Gregory Box
for continuous positive
airway pressure
1971
J. Kattwinkel
A device for
administration of
continuous positive
airway pressure by the
nasal route
1973
2 NEJM case series
demonstrate
pharmacologic closure
of the PDA with
indomethacin (the
therapy was
immediately adopted
around the world)
1976
Exosurf
(an artificial surfactant)
is shown to be effective
by multinational RCTs
and is approved by FDA
1990-1991
High frequency
oscillatory
ventilators become
commercially
With the combination of pulse
available
Pulse oximetry
oximetry, gentler ventilation
1990
widely
strategies (including the concept
available in
of permissive hypercapnea) and
newborns
completion of the 30 year quest
RCT:
1987
for artificial surfactant,
cryotherapy for
neonatologists go from saving
retinopathy of
near term infants to ratcheting
prematurity
down the gestational survival
1985
limits to the second trimester
fetus. Cerebral palsy incidence
is unchanged.
Neonatology opens Pandora’s Box
P.V. Gordon et al.
Multiple RCTs test
demonstrate that early
early postnatal
postnatal steroids in
dexamethasone’s for combination with early
attenuation of
indomethacin increase
chronic lung disease spontaneous intestinal
( associated with CP
perforations
& intestinal
1999-2007
perforations)
1999-2001
FDA approves Nitric
Oxide for treatment
of pulmonary
hypertension in the
What we seem to be learning in
newborn
the post surfactant age is that the
1997
important limits to neonatology
L. Van Marter
may not be viability, it may be the
Cohort study
capacity to develop an ex utero
demonstrating
fetus into a functional human being
antenatal steroids
who has meaningful quality of life.
reduce the incidence
We are in fact creating entirely
of BPD
new disorders in these survivors.
1990
Neonatology keeps prying open Pandora’s Box
PV Gordon
What can we learn from history?
1) Neonatology has fathered most of the pediatric
subspecialties we know today.
2) Much of our progress has come about because of
society, not in spite of it.
3) Progress had not been always forward, but
saltatory, with advances and set backs in
accordance with the accuracy of our understanding
of fetal and neonatal biology.
4) There are many Living Legends in Neonatology and
there’s still plenty of room for others to join them.