Early Neonatal Research at Wilford Hall US Air Force Medical Center

Abstract

* Abbreviations: AFB — : Air Force Base ECMO — : extracorporeal membrane oxygenation HFOV — : high-frequency oscillatory ventilation HFV — : high frequency ventilation IMV — : intermittent mandatory ventilation PEEP — : positive end-expiratory pressure RDS — : respiratory distress syndrome USAF — : US Air Force The beginning of the many contributions to the field of neonatology originating from Wilford Hall Air Force Medical Center began when Robert deLemos, MD (Col, retired US Air Force [USAF]), was assigned to Lackland Air Force Base (AFB) in the summer of 1969. When Dr deLemos came to Texas, he was the first and only fully trained Air Force neonatologist at a time when neonatal medicine was still just in its infancy. Although surfactant deficiency had been described as the cause of hyaline membrane disease by Dr Avery in her landmark article published in 1959, surfactant replacement therapy in premature infants did not begin until the 1980s after the work of Dr Fujiwara et al was reported in Lancet .1,2 Morbidity and mortality remained high in premature infants, especially in those under 1500 g with respiratory distress syndrome (RDS). Reports published in the 1960s and 1970s described early attempts at the use of mechanical ventilation to rescue neonates with respiratory failure, but ventilator options were limited and devices were not widely available, resulting in minimal success.3,4 Given this backdrop, the story of the accomplishments of a relatively small group of military neonatologists led by Dr deLemos takes on added historical significance. Some of the most important initial work completed by Dr deLemos and his colleagues centered on their efforts to improve respiratory support and cardiovascular monitoring in the critically ill neonate. In the late 1960s and early 1970s, physiologic monitoring of the neonate was very difficult. Blood pressure could only be accurately obtained by using indwelling arterial lines. Ventilators in this time period only provided flow during the inspiratory cycle. If patients breathed between ventilator breaths, they were rebreathing their own exhaled gas contributing to impaired ventilation and oxygenation. In neonates this required mechanical … Address correspondence to Robert J. DiGeronimo, MD (Col, retired US Air Force), 295 Chipeta Way, Salt Lake City, UT 84158-1289. E-mail: robert.digeronimo{at}hsc.utah.edu