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20 Working Nurse l WorkingNurse.com January 13–February 17, 2020 PROFILES IN NURSING by Aaron Severson W hen Evelyn Lundeen began the job that would become her life's work, neonatology as we know it was barely practiced in the U.S. By the time she died almost 40 years later, Lundeen had not only saved the lives of thousands of premature infants, but also helped to elevate the standard of care for preemies everywhere. Incubators and Innovation A century ago, babies born prematurely faced grim odds of survival. Most children were born at home, and many hospitals refused to admit neonates not born in that institution. Even if they did, few American physicians studied or practiced the care of preterm infants. Incubators for newborns were widely regarded as carni- val gimmicks rather than practical medical technology. Chicago pediatrician and pediatrics professor Julius Hess, M.D., felt different- ly. Hess had studied the European litera- ture on caring for preemies, which emphasized consistent temperature and isolation from pathogens. He was also friends with Martin Couney, M.D., a physi- cian and impresario responsible for many sideshow exhibitions of babies in incuba- tors. Inspired, Hess developed his own incu- bator, the Hess bed, an electrically heated device that looked and worked something like a giant double boiler. A few years later, he also wrote the first American medical text on premature infant care. In 1922, Hess received a sizable gift from the Infants' Aid Society to establish the Premature Infant Care Station at Sarah Morris Children's Hospital in Chicago — the first station of its kind in the U.S. Soon after, he hired Evelyn Lundeen, RN, a young nurse who'd gradu- ated from Lutheran Hospital School of Nursing in Moline, Ill. It was the beginning of a three-decade professional partnership. Although Hess was probably America's leading neonatol- ogy expert, writing numerous important books and studies on the subject — some of them in collaboration with Lundeen — he recognized that the actual work of keeping preemies alive was a job for skilled, dedicated nurses. A Mustard Bath and a Drop of Whiskey Even today, caring for infants born preterm or with congenital illnesses is a challenge. For Lundeen and the nurses she trained and supervised, it meant stooping over the Hess beds to check on infants who couldn't be seen through the incubator's opaque metal walls and whom the nurses were ordered to handle as little as possible. To minimize the risk of infec- tion, the nurses scrubbed like they were going into surgery and wore full masks and gowns for all patient contact. Nutrition and patient education were also priorities. Lundeen and Hess found that preterm and low birth weight infants who received human milk had dramatical- ly better outcomes than those who received formula. Lundeen and her nurses encouraged new mothers to breastfeed after discharge and offered guidance on breast pumping and maternal diet. The nurses also managed the supplemental Evelyn Lundeen, RN (1900–1963) Setting the standards for neonatology care A physician who knew Lundeen described her as "an autocrat who knew more about the care of the premature than the doctors did." THE HESS INCUBATOR The "Hess bed" placed a bassinet within an electrically heated metal water jacket, using a thermostat to maintain the proper temperature. One downside: Nurses couldn't see the patient inside! Photo: Neonatology.org