Further Developments in Fetal and Neonatal Physiology

Abstract

An example of the manner in which discoveries in fundamental physiology and biochemistry have combined with clinical investigation to impact care of the newborn infant, perhaps no more striking instance, is that of an understanding of the lung and the changes that occur at birth. Survival at birth depends on the optimal development and maturation of the lung in utero. Disorders of lung growth, maturation, and regulation of respiration continue to be among the most important problems with which the neonatologist has to deal. As noted above, in the USA, as well as throughout the world, premature birth occurs in 7–12% of pregnancies, a major complication of which is pulmonary immaturity with resultant respiratory distress syndrome (RDS). Affecting more than 10% of infants born prematurely, RDS is characterized by tachypnea, cyanosis, grunting, and intercostal and subcostal chest wall retractions. The potentially devastating consequences, with both short- and long-term complications, include alveolar rupture, development of pneumothorax, pulmonary interstitial emphysema, and other conditions. In the USA alone during the 1950s, this condition claimed the lives of more than 10,000 infants a year. A monumental discovery was that inadequate pulmonary surfactant was associated with altered pulmonary function and respiratory disease of the newborn. In this instance, the genesis of a clinical problem was elucidated in the laboratory by collaboration of basic scientists and clinicians, driven by curiosity and working to saving the lives of prematurely born infants.

….It is not in the nature of things for any one man to make a sudden violent discovery; science goes step by step, and every man depends on the work of his predecessors. When you hear of a sudden unexpected discovery—a bolt from the blue, as it were—you can always be sure that it has grown up by the influence of one man on another, and it is this mutual influence which makes the enormous possibility of scientific advance. Scientists are not dependent on the ideas of a single man, but on the combined wisdom of thousands of men, all thinking of the same problem, and each doing his little bit to add to the great structure of knowledge which is gradually being erected.

Lord Rutherford (in Cohen 1960, p. 112)