Credit: Melissa Bates
In 1963, President John Kennedy’s wife, Jackie, gave birth to a little boy three weeks early. The baby survived only 39 hours before dying of hyaline membrane disease, more commonly known as respiratory distress syndrome. The first successful treatments began in 1991, and now nearly 99 percent of babies like the Kennedy baby survive prematurity. Physicians are even able to treat babies born as much as 16 weeks early. This also means that the first large-scale group of people with hyaline membrane disease to survive being born prematurely is only 24 years old. What does the future hold for this population?
Hyaline membrane disease is caused by a deficiency in the molecule surfactant. Surfactant is produced in the lung starting shortly before birth and is critical for the lungs to inflate and the lungs’ surface to stay dry. To treat the disease, premature babies are given surfactant derived from animals. In addition to surfactant, supplemental oxygen is given and babies are placed on mechanical ventilators.
We recently found that adults who had been born prematurely had important, but unexpected, changes in their physiology. For example, unlike their peers who were born at full term, prematurely born adults couldn’t increase their breathing in a low-oxygen environment. We also discovered that their exercise capacity and the ability of their lungs to take up oxygen were reduced. We were really struck by this because these prematurely born adults looked just as healthy as adults born at term, until they were stressed with exercise or a low-oxygen environment.
Although we studied minor stresses in a healthy population, we think that our experiments offer a clue that a bigger problem exists on the horizon. Soon, this young population will begin to age. We’ve already found that their physiology is different. Given the current success in treating premature infants now, it is absolutely vital that we shift some of our scientific focus to figuring out whether their different physiology puts them at higher risk of age-related diseases, such as high blood pressure, pulmonary hypertension and diabetes, in the future.
Melissa Bates, PhD, is an assistant professor of human physiology at the University of Iowa.
Correction (10/22/15): An earlier version had said that the baby was born in 1967. The correct year was 1963, and the post has been revised.
Interesting post. One thing though. President Kennedy was not alive in 1967. Did you mean 1957?
It is a typo. The year is 1963. Thank you for the comment!
It is well known that preterm infants often have compromised lung function life-long. Many of them are diagnosed with the chronic lung disease Bronchopulmonary Dysplasia within the first month of life, which currently has no effective treatment. But there have been many significant advances in Neonatology over the 25 years since the participants in the study alluded to in this Blog were born that have reduced the negative consequences of mechanical ventilation and oxygen exposure. It has always been understood that the interventions to save preterm infants would have to be evaluated on an on-going basis given that the survival of these infants had no precedents- prior to the advent of Neonatology as a clinical discipline the vast majority of preterm infants died. It was only because of the diligent and systematic application of simple procedures like glucose on the tongue and warming lights that Neonatology came into existence at all. The subsequent use of steroid hormones to accelerate the development of the fetal lung for the prevention of Respiratory Distress Syndrome (the disease the Kennedy baby died of in 1963) demonstrated the great potential for these infants to survive and thrive, given the opportunity. Work in our laboratory on the fundamental principles of lung development and that of many others will eventually resolve these problems; to my mind, that is where our efforts and resources should be placed, not with the further characterization of the side effects of life-saving efforts.
Thanks so much for your comment on our post. I am frequently amazed at how much progress science and medicine has made in the last 25 years and frequently think about the physiology of these babies. There is no doubt in my mind that they are born during a critical developmental window and that even these lifesaving treatments may impact their development. We think a lot, as scientists, about the problems they face immediately after birth but I also wonder about what is going to happen to these folks as they now reach middle age. I also wonder about systems beyond the lung – metabolism, cardiovascular, brain, etc. Clearly we have a lot of work to do!!!
I was a premature infant born at 31 weeks in 1977. I was dx with mild asthma as a child and have had pneumonia three times in my mid 30’s. I am a healthy active 38 year old and I feel like I have the lungs of a 70 year old. Is there a study or more information I can be a part of to find out more about my lungs and what I have to look “forward” to?