Big problems for small lungs  pg. 2

“You may save their life but do terrible things to their lungs,” says Mildred Stahlman, M.D., professor of Pediatrics and Pathology at Vanderbilt University Medical Center.

Mildred Stahlman, M.D., holds Cole
Petty, 101 days after he was born
prematurely weighing 470 grams
(a little over 1 pound).
Photo by Joe Howell
 Stahlman, a pioneer in the field of neonatology, is credited with setting up the nation’s first neonatal intensive care unit (NICU) at Vanderbilt in the 1960s. It was largely through her efforts that ventilators were adapted to meet the needs of premature infants more than 50 years ago.

“Early on we knew there was damage of some sort caused by the ventilation, but you don’t know exactly what you’re doing to the blood flow, or to the structure,” she says. “There are just a million questions. You answer one question and it asks another.”

Gentler approach

The questions doctors asked over the years led to the development of many important treatment advances: steroids to mature the lungs before delivery, surfactant to artificially lubricate and protect premature lungs, advanced infection control, and finely tuned ventilator settings and oxygen delivery systems.

Today, babies born even at 23 weeks of gestation can survive. But as smaller babies survive at earlier stages of gestation, a much more complex picture of lung damage is forming.

For Vanderbilt neonatologist Mario Rojas, M.D., M.P.H., one answer may lie in avoiding the use of ventilators unless absolutely necessary, and opting instead for the gentlest possible approach for premature respiratory support.

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