Circulatory Factors in Relation to Idiopathic Respiratory Distress (Hyaline Membrane Disease) in the Newborn:

The foundations on which “neonatology” rest today were being established by pioneering pediatricians and physiologists in the 1950s. Among the most prominent was Clement Smith, mentor to a group of clinician-scientists who ultimately became the leaders of the practice of neonatology. In his article we find an open, questioning discussion regarding what was still a mysterious, almost always lethal disorder affecting preterm infants. The article reveals his deep desire to understand and ultimately treat this common clinical problem. However, the concepts were dominated by newly generated data from cardiovascular physiology laboratories. With the hindsight, we can see that his inability to grasp in the intersection of cardiovascular physiology and the pathogenesis of hyaline membrane disease (HMD) lie with a lack of fundamental data regarding biochemistry, biophysics, and physiology. His musings are not out of place, for now 50 years later, we embrace our own frustrations in understanding and treating necrotizing enterocolitis, premature birth, bronchopulmonary dysplasia, and intraventricular hemorrhage in the same way.