Sometimes, it’s easy to forget how far we have come in the past fifty years. On August 7, 1963, First Lady Jackie Kennedy delivered her second son, Patrick Bouvier Kennedy. The baby was five and a half weeks premature and weighed 4 pounds 10 ½ ounces. Today, a baby born at 34 weeks enjoys a 98% survival rate. However, in 1963, if the premature baby developed respiratory distress, odds were that the baby would die. There simply was no treatment at that time. Sadly, in the early morning hours of August 9, 1963, as President Kennedy stood watch, Patrick Kennedy succumbed to “hyaline membrane disease”, despite being cared for by the most knowledgable medical team in the country.
Interestingly, when Patrick Kennedy died, most doctors didn’t even really understand what caused “hyaline membrane disease”. The common theory was that a glassy membrane formed making it nearly impossible for the baby’s lungs to extract sufficient oxygen when air was inhaled. However, after decades of research, doctors finally realized that
(h)yaline membrane disease was not caused by the presence of something in the lungs but rather by the absence of something. The lungs of babies who died of hyaline membrane disease lacked a substance called surfactant, which lines the alveoli, the small air sacs at the end of the lungs’ numerous, branching airways. The problem did not lie only with breathing in, as had long been assumed, but also with breathing out. The baby took that first breath, perhaps even a good deep breath, as any baby would. But if the newborn baby’s immature lungs lacked surfactant, the alveoli tended to collapse when the baby breathed out.
This understanding led to the eventual development of artificial surfactants, the practice of giving steroids (which speed up the natural production of surfactant) to women at risk of premature labor, and the introduction of better ventilator/respirator technology & methods.
When people ask me if I want to return to a simpler time such as the 1950s or early 60s, I always think (for many reasons), “Are you crazy?" I have no desire to return to a time where infants born at 34 weeks had a 3% survival rate. Today that survival figure is 98%. Think about that. It’s a truly remarkable turnaround in a relatively short number of years. On what would have been his 49th birthday, I pause to pay respects to baby Patrick whose short life undoubtedly attracted public attention to hyaline membrane disease and helped fuel further research, leading to effective treatments that save the lives of tens of thousands of newborns each year.