In a clinical trial from 1969 to 1972, Sir Graham Collingwood Liggins and Ross Howie showed that if doctors treat pregnant women with corticosteroids before those women deliver prematurely, then those women's infants have fewer cases of respiratory distress syndrome than do similarly premature infants of women not treated with corticosteroids. Prior to the study, premature infants born before 32 weeks of gestation often died of respiratory distress syndrome, or the inability to inflate immature lungs. Liggins and Howie, then both at the University of Auckland in Auckland, New Zealand, published their results in A Controlled Trial of Antepartum Glucorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants in 1972. The study built on experiments Liggins had earlier conducted with sheep. Liggins' corticosteroid experiments changed the way doctors treated pregnant women experiencing preterm labors, and they improved the life expectancy of prematurely born infants.
During the late 1800s and early 1900s, physician Martin Couney held incubator exhibits to demonstrate the efficacy of infant incubators throughout the US and Europe. At his exhibits, Couney demonstrated that isolating premature infants in an incubator ward could significantly decrease premature infant mortality and increased the use of incubators in the US.
Virginia Apgar and colleagues wrote “Evaluation of the Newborn Infant—Second Report” in 1958. This article explained that Apgar’s system for evaluating infants’ condition after birth accurately predicted the health of infants. Apgar had developed the scoring system in 1953 to provide a simple method for determining if an infant needed medical attention after birth. The research team, working at Columbia University College of Physicians and Surgeons in New York City, New York, studied the Apgar scores of over 15,000 infants from Sloane Hospital for Women in New York City, New York, over a period of five years. In “Evaluation of the Newborn Infant—Second Report,” Apgar and colleagues established that Apgar scores correlated with infants’ health directly after birth and indicated when medical personnel should treat the infant.
Sindell v. Abbott Laboratories was a 1980 California case that established the doctrine of market share liability for personal injury cases. For such liability, when a drug causes personal injury and the manufacturer of the drug cannot be identified, each producer is responsible for paying the settlement in proportion to the percentage of the market they supplied. Judith Sindell and Maureen Rogers brought the case against the producers of diethylstilbestrol (DES), which their mothers had taken during pregnancy to prevent miscarriage and other complications. Sindell and Rogers alleged that their mothers' ingestions of DES during pregnancy later caused Sindell and Rogers to develop cancers at the onset of puberty, but they could not identify the specific manufacturer of the drug. The market share liability ruling in Sindell allowed millions of DES-affected individuals to seek restitution for reproductive cancers caused by prenatal exposure to DES.
Etienne Stephane Tarnier was a physician who worked with premature infants in France during the nineteenth century. He worked at the Maternité Port-Royal in Paris, France, a hospital for poor pregnant women. Tarnier developed and introduced prototypes of infant incubators to the Maternité in 1881. Tarnier's incubators became standard in neonatal care, especially for premature infants, enabling doctors to save many such infants that previously would have died.
In the nineteenth century, obstetricians in Europe began to construct devices to incubate infants in increasingly controlled environments. The infant incubator is a medical device that maintains stable conditions and a germ free environment for premature infants born before the thirty-seventh week of pregnancy. Records show that physicians had used infant incubators since 1835. However, Jean-Louis-Paul Denuce, a physician who worked in Bordeaux, France, first published about incubator technology in 1857. Carl Crede released his incubator model in Germany in 1860 and Stephane Tarnier further developed the model in 1884. The infant incubator technology provides a stable environment for premature infants and helps keep them alive.
Pierre Constant Budin worked in France to improve the lives of newborns and their mothers during the late nineteenth century. Budin stressed the importance of proper nutrition in infants and educated new mothers on breastfeeding and infant care. Budin established infant care facilities and created a nutritional check-up system for infants. Budin helped design early artificial nipples, breast pumps, and incubators for premature newborns. He also began the practice of consulting with new mothers after they gave birth, redefining the roles of obstetricians.
Alexandre Lion established incubator charities in the late 1890s in France to promote his infant incubator. Lion’s infant incubators kept premature infants warm and improved their chances of survival, but were expensive and not widely used. In order to promote his new technology, Lion displayed incubators that carried premature infants in storefronts and at fairs and expositions throughout Europe. After the public began paying admission to view the infants and incubators, the expositions became incubator charities. Admission fees went directly to the care of the premature infants. The charities treated roughly 8,000 premature infants and greater than 7,500 of them survived. The charities in France occurred in Paris, Nice, Marseille, Bordeaux, and Lyon. The charities in Belgium were located in Liège and Brussels.
In the 2003 article “Kangaroo Care Is Effective in Diminishing Pain Response in Preterm Neonates”, Celeste Johnston, Bonnie Stevens, Janet Pinelli, and their colleagues evaluate the effectiveness of the Kangaroo Mother Care position in decreasing the pain response of preterm infants who undergo a heel lance procedure for blood collection. Kangaroo Mother Care is a method of treatment for premature and low birth weight infants that involves exclusive breastfeeding and skin-to-skin contact between a mother and her infant in what is called the kangaroo position. After researchers supported the use of Kangaroo Mother Care for basic care, they began to search for other uses of Kangaroo Care in the neonatal intensive care unit, or NICU. In their article, the authors demonstrate that the skin-to-skin contact involved in the Kangaroo Mother Care decreased the amount of pain premature infants experienced during a heel lance, a frequently used NICU procedure.