Pediatric Annals

A Pediatrician's View

Milton I Levine, MD

Abstract

It may seem strange to the modern pediatrician, but the fact remains that until the late 1930s care of the newborn was almost entirely in the hands of obstetricians. There was a large group of physicians called "women and children's specialists," and many obstetricians jealously cared for their newborns at least throughout the first year.

I went through my internship and residency at two of the famous pediatric hospitals in the late '20s; but we saw no newborns unless they had some severe birth defect, such as hydrocephalus, harelip and cleft palate, or a severe congenital heart defect. It was necessary for me to take a special obstetric internship at Bellevue Hospital so that I could observe and care for newborns.

In the early 1930s, very little was known concerning the perinatal period - the most crucial period of life. Death certificates recorded innumerable cases of "asphyxia of the newborn," "stillbirth," and "prematurity." Oxygen in high concentrations was a primary method of treatment, and often severely jaundiced babies who became anemic were given repeated infusions of their mothers' blood - for surely "mother's blood is best for her baby."

It was during this period of limited knowledge that the Special Committee on Infant Mortality was organized under the auspices of the Medical Society of the County of New York. As could be expected, at first it involved only the obstetricians and hospital administrators.

But in 1936 the Division of Maternity and Newborn Services of the New York City Department of Health became involved in the work of the committee. Dr. Harold Abramson, a pediatrician who was epidemiologist for the Division, became associated with the Committee on Infant Mortality and from that time on was an inspiring force on it for the remainder of his life. He concerned himself with improved obstetric care, resuscitation, premature care (including the premature transportation service), neonatal infections, and, later, intensive-care units. Symposiums, lectures, and motion pictures were presented to educate the medical community.

It was only natural then that, in seeking a Guest Editor for an issue of Pediatric Annals on neonatal morbidity, I should turn to Dr. Abramson, who was then chairman of the Committee on Infant Mortality. It was decided that Dr. Charles H. Bauer, a member of the committee, would be co-Guest Editor.

Dr. Abramson enthusiastically set about selecting contributors but suddenly died in October, 1974. The selection was continued by Dr. Bauer.

The first article in this issue of Pediatric Annals is a historical review by Dr. Abramson of the work and attainments of the Special Committee throughout the years. It portrays the numerous efforts of this group aimed at reducing if not eliminating many of the hazards of the neonatal period. A simple reading of the subjects presented to physicians in lectures, symposiums, movies, and publications gives us some idea not only of the energy and vigor of this committee in the past 37 years but also of the accomplishments of medical science in the field of neonatology during that period.

This article is followed by an important contribution on "Infant Transport Services," by Drs. Angelo Ferrara and Lucille Perrotta. It has, for the past two decades, been realized that one of the most significant means of reducing newborn mortality is by having the highrisk infant cared for in a unit equipped for that specific purpose (more recently defined as the "newborn intensive-care unit"). Most hospitals in the United States are not equipped with such units, and a special infant transport service must be organized and used. This article presents a superb description of the organization of such a service,…

It may seem strange to the modern pediatrician, but the fact remains that until the late 1930s care of the newborn was almost entirely in the hands of obstetricians. There was a large group of physicians called "women and children's specialists," and many obstetricians jealously cared for their newborns at least throughout the first year.

I went through my internship and residency at two of the famous pediatric hospitals in the late '20s; but we saw no newborns unless they had some severe birth defect, such as hydrocephalus, harelip and cleft palate, or a severe congenital heart defect. It was necessary for me to take a special obstetric internship at Bellevue Hospital so that I could observe and care for newborns.

In the early 1930s, very little was known concerning the perinatal period - the most crucial period of life. Death certificates recorded innumerable cases of "asphyxia of the newborn," "stillbirth," and "prematurity." Oxygen in high concentrations was a primary method of treatment, and often severely jaundiced babies who became anemic were given repeated infusions of their mothers' blood - for surely "mother's blood is best for her baby."

It was during this period of limited knowledge that the Special Committee on Infant Mortality was organized under the auspices of the Medical Society of the County of New York. As could be expected, at first it involved only the obstetricians and hospital administrators.

But in 1936 the Division of Maternity and Newborn Services of the New York City Department of Health became involved in the work of the committee. Dr. Harold Abramson, a pediatrician who was epidemiologist for the Division, became associated with the Committee on Infant Mortality and from that time on was an inspiring force on it for the remainder of his life. He concerned himself with improved obstetric care, resuscitation, premature care (including the premature transportation service), neonatal infections, and, later, intensive-care units. Symposiums, lectures, and motion pictures were presented to educate the medical community.

It was only natural then that, in seeking a Guest Editor for an issue of Pediatric Annals on neonatal morbidity, I should turn to Dr. Abramson, who was then chairman of the Committee on Infant Mortality. It was decided that Dr. Charles H. Bauer, a member of the committee, would be co-Guest Editor.

Dr. Abramson enthusiastically set about selecting contributors but suddenly died in October, 1974. The selection was continued by Dr. Bauer.

The first article in this issue of Pediatric Annals is a historical review by Dr. Abramson of the work and attainments of the Special Committee throughout the years. It portrays the numerous efforts of this group aimed at reducing if not eliminating many of the hazards of the neonatal period. A simple reading of the subjects presented to physicians in lectures, symposiums, movies, and publications gives us some idea not only of the energy and vigor of this committee in the past 37 years but also of the accomplishments of medical science in the field of neonatology during that period.

This article is followed by an important contribution on "Infant Transport Services," by Drs. Angelo Ferrara and Lucille Perrotta. It has, for the past two decades, been realized that one of the most significant means of reducing newborn mortality is by having the highrisk infant cared for in a unit equipped for that specific purpose (more recently defined as the "newborn intensive-care unit"). Most hospitals in the United States are not equipped with such units, and a special infant transport service must be organized and used. This article presents a superb description of the organization of such a service, including the training of personnel, the equipment needed, the type of vehicle recommended, and even the cost of operating the service.

The three subsequent articles present a symposium on infections in the neonatal period. It starts with a discussion, by Dr. Stephen R. Kandall, on the means of preventing or controlling bacterial infection in the nursery. This is an excellent coverage of one of the most difficult problems in the newborn nursery.

The next contribution - "Neonatal Sepsis," by Drs. Sophie Pierog and Sarvesh Nigam - is a complete review of the subject, covering pathogenesis, signs and symptoms, and supportive treatment.

A complete discussion of treatment is given by Dr. Anne A. Gershon in her article on "The Use of Antibiotics for Severe Neonatal Infections." This deals fully with both sepsis and meningitis and should be of great value to all pediatricians treating such cases.

Another important aspect of neonatal morbidity is covered in the article on "Nonhemolytic Hyperbilirubinemia in Full-Term Infants," by Drs. Charles H. Bauer and Terusada Horiguchi. This subject is still open to controversy, first as to what specifically is the level of hyperbilirubinemia requiring treatment and then whether treatment should be by lights or by exchange transfusions. The authors clearly discuss this controversy and present the treatment they have found most successful.

The final contribution deals with the "Torch Syndrome," named from the first letters of four infections that may affect the fetus - toxoplasmosis, rubella, cytomegalovirus, and herpes simplex.

The pathogenesis, diagnosis, prognosis, and pathologic findings are presented for each of these conditions. Although completely successful treatment has not been reported for any of these conditions, the successful treatment of an infant with cytomegalovirus infection was recently reported from the North Shore Hospital in Long Island, New York. The authors of the article on the "Torch Syndrome" are Drs. Yong Ho Shin, Leonard Glass, and Hugh E. Evans.

This issue, then, covers some of the subjects of major importance in infant morbidity. A future issue will be devoted to erythroblastosis fetalis, the respiratory distress syndrome, and the newborn intensive -care unit.

10.3928/0090-4481-19760201-03

Sign up to receive

Journal E-contents