INTRODUCTION

All neonatologists must be pioneers by definition, because we are now looking after infants who would not have survived before. Every year is a new experience as we have the pleasure of seeing more and more low birth weight infants survive, and we accept the challenge of reducing their continuing morbidities.

Modern neonatology begins in the 1940s. One of the reasons it began, I think, was post World War II construction, new facilities, and, alas, a tragedythe emergence of the leading cause of blindness in children in the United States; we now call it retinopathy of prematurity. In the late 1940s, it was called retrolental fibroplasia and was the leading cause of blindness among children in the United States. Recognition, in the 1950s, that the cause was hyperoxia led to better monitoring of oxygen delivery and a near elimination of the problem among infants weighing >1800 g.

In 1940, there was a 50% survival rate of infants whose birth weights were <1800 g at 28 days. The overall neonatal mortality rate was 29 per 1000 live births. In comparison, in 1994 it was 5 per 1000 live births. This 50% survival rate was a function of multiple events.

New premature nurseries were built and people were putting an emphasis on the needs of newborn infants after World War II. We began to have better instrumentation. We went through a misadventure with restricted oxygen use in the 1950s and most infants died of respiratory distress. There were no ventilators and no blood gas measurements. Pathologists played an enormously important role by saying over and over again these infants' lungs had something that looked like hyaline membranes and atelectasis.

Pathologists such as Peter Gruenwald, George Anderson, . . . [Full Text of this Article]