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American Academy of Pediatrics
Article

Historical Perspectives: Beyond the First Breath: Hyaline Membrane Disease and Constructing the Neonatal Patient, 1959–1975

Deniz Cataltepe
NeoReviews November 2018, 19 (11) e636-e644; DOI: https://doi.org/10.1542/neo.19-11-e636
Deniz Cataltepe
*University of Massachusetts Medical School, Worcester, MA, and Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK
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  • Abbreviations:
    HMD:
    hyaline membrane disease
    NIH:
    National Institutes of Health
    UCLA:
    University of California, Los Angeles
  • Mary Ellen Avery, MD. Photograph kindly provided by Rosalind S. Brown, MD.

    Introduction

    How do the lungs of newborns support their first breaths, and why do some infants develop respiratory distress? This crucial research question emerged in the 1950s and was investigated by numerous physicians and scientists, including the American pediatrician Mary Ellen Avery, who devoted her career to the regulation of infant respiration. In a 1964 lecture, Avery drew a distinction between the intrauterine and extrauterine environments stating that “It is clearly at birth that regular rhythmic respiration begins. Something is turned on, something must be different just after birth from the way it was before, and this something must be essential to the regulation of respiration.”(1)

    Although Avery was a physician by training and not a scientist, research played a significant role in her career and led to her prominence as one of the investigational leaders of respiratory distress syndrome, which was known as hyaline membrane disease (HMD) during the time of Avery’s research. Avery focused on the role of surfactant, specifically its deficiency in HMD, challenging the accepted view at the time that HMD was caused by an obstruction in the lungs due to the aspiration of hyaline membranes. (2)(3)(4) Avery’s act of shifting the understanding of HMD from an obstructive disease to one of a biochemical deficiency was all the more striking given her role as a pediatrician and not a formally trained laboratory scientist. Biographers have estimated that her findings on HMD and their subsequent translation to treatment in the form of surfactant replacement have saved the lives of more than 800,000 infants. (2)

    The discovery of surfactant deficiency as the cause of HMD in 1959 not only challenged the accepted understanding of the disease at the time, but …

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    NeoReviews
    Vol. 19, Issue 11
    1 Nov 2018
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    Historical Perspectives: Beyond the First Breath: Hyaline Membrane Disease and Constructing the Neonatal Patient, 1959–1975
    Deniz Cataltepe
    NeoReviews Nov 2018, 19 (11) e636-e644; DOI: 10.1542/neo.19-11-e636

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    Historical Perspectives: Beyond the First Breath: Hyaline Membrane Disease and Constructing the Neonatal Patient, 1959–1975
    Deniz Cataltepe
    NeoReviews Nov 2018, 19 (11) e636-e644; DOI: 10.1542/neo.19-11-e636
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    • Article
      • Introduction
      • Pediatrics, Obstetrics, and the “Newborn Patient”
      • HMD and the Collaboration Between Pediatrics and Physiology
      • Translating the Physical-Chemical Method for Pediatricians
      • Reconstructing the Neonatal Patient
      • Conclusion
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