Perspectives on neonatal research: what the young neonatolo-gist needs to learn from the older ones, and vice versa

摘要

Since you have invited a galaxy of experts on respiratory problems of the newborn, I shall look forward to hearing of their latest research, and will focus my thoughts on how did we discover what we now know. I begin with some early observations that are best summarized by the former names of hyaline membrane disease (HMD) or respiratory distress syndrome (RDS). This condition was recognized from the early days of this past century by a pathologist Hochheim in 1903. Landmarks in discovery are shown in Tab 1. The theories of pathogenesis arose from the awareness that the pulmonary findings were more common the more premature the infant, and that the onset of respiratory distress was usually shortly after birth, and the so-called membranes were not found in stillborn infants, but were acquired in the hours after birth, when an inflammatory component became prominent. When improved ventilatory support became available, and microchemjcal analyses allowed measurement of electrolytes and blood gases, it was evident that the infants were profoundly hypoxic even in the presence of high inspired oxygen concentration, that was proof of serious derangements in ventilation/per-fusion ratios, from right-to-left vascular shunts within the lung as well as right-to-left blood flow through an often persistent patent ductus arteriosus.