pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

You’ve Come A Long Way Baby

I should like to tell you today about a better use for the slogan “you’ve come a long way baby” than was previously expressed in an advertising campaign.

Many don’t realize that it has only been 30 – 50 years ago that very literally every family had one or two children die in infancy; and nearly everyone knew of several women who had died in childbirth.

There have been some improvements and infants have indeed come a long way.

Some physician friends of mine, neonatologists who run a newborn intensive care center, were speaking to me of these advances some time ago.

I told them how my grandmother had related the advice which her doctors gave her as she was caring for a premature baby.

It was common practice to tell the parents to keep the baby in the oven (with the door open).  This would supply the needed warmth.

Evidently, the Dion quintuplets were cared for in this manner as well.

She was also told to have my grandfather milk all of their cows, testing the milk to find the one with the smallest curd size.

That was the cow that was set aside from all the others in a special area of the barn, being kept clean and given the royal treatment as the “baby’s cow.”

You may have heard that the first major breakthrough in infant mortality was when physicians realized they should wash their hands when they attended a delivery.  The deaths of infants and mothers from childbed fever have almost disappeared.

The second major drop in infant mortality came when antibiotics were discovered.

Deaths of babies who were infected with bacteria types sensitive to the antibiotics were prevented.  In the rush to use antibiotics and invent new medicines, some mistakes were made and babies even died while the correct dosages were found.

However, many more babies were saved from diseases which were then so mysterious that they simply called them “the fever.”

Shortly after that some courageous physicians, now tired of having infants and children placed in the hospitals leftover beds or in the back room (where they couldn’t be heard), began to specialize in the treatment of children.  This, I suppose, was much to the chagrin of some of their colleagues.

Many children and infants were being harmed as much by the care from well-meaning but misinformed general practitioners of the time, than the illness itself.

The American Academy of Pediatrics was formed, which encouraged the study of medical care of children.  This event, although indirect, has contributed to the increase in children’s quality of care as much as any other single thing.

Infant formulas were developed and, although by today’s standards were very crude, saved literally thousands of babies every year whose mother’s couldn’t breast-feed them.

There are still countries today in which children of mothers who cannot breast-feed, die of malnutrition and starvation.

The formulas of today are highly refined and nourishing.  We even have some specially for premature infants.

The so-called incubator is another landmark step in saving infants lives.  It was first widely shown at a Worlds Fair where several newborn babies were kept alive in the contraption and were on exhibit at the fair.

We call them isolettes now and they have become so sophisticated and complicated that many interns and nurses refer to them as “the Cadillac” (because they cost more than a Cadillac).

In our lifetime we have seen at least two other major technical developments which have increased infant survival: C-Pap (respirator treatment), and fetal monitoring.

It was found, by a physician in California, that premature infants lack a soap-like substance in their lungs, called surfactant, which allows the air sacs to keep open.  He invented a respirator device which artificially helps keep the babies lungs open slightly, until old enough to develop it’s own surfactant.

This technique has been refined and is in universal use in newborn intensive care centers throughout the world.

Fetal monitoring was developed to pick up problems the baby was having during the birthing process.  In the past, the first time you knew that there had been any problems was when the baby was delivered either stillborn or extremely asphyxiated.  Even with the most careful human monitoring.

By checking the babies heart rate continuously during labor, we can often pick up even the earliest signs of an infant in distress, and correct the situation.

This type of skilled monitoring is not available during home or other out of hospital births.  And in my opinion, places the baby at a significant and, in this day in age, unwarranted risk.

A newborn ICU where I trained had only 18 extremely ill and premature babies expire out of 475 that we cared for.

That was a mortality of only 8.8%, which was better than the National average at the time.  Now it’s even lower.  The greatest percentage of the deaths occurred in infants born premature and weighing less than 7/8 of a pound.  Now we routinely save babies even lower weight that that.

Neonatologists are still making great improvements nearly all the time by discoveries and understanding of infants bodily fluids and metabolism.

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