THE JOURNAL OF PEDIATRICS MCCAIN ET AL

VOLUME 139, NUMBER 3

379

50 Years Ago in The Journal of PediatricsEXCHANGE TRANSFUSION FOR FETAL ERYTHROBLASTOSIS

Kaessler HW, Ledgard JJ. J Pediatr 1951;39:174-9

When I began a pediatric residency in the late 1960s, hemolytic disease of the newborn was probably the secondmost common admitting diagnosis in the Special Care Nursery at Cincinnati Children’s Hospital. An article onneonatal hemolytic disease, which appeared in The Journal of Pediatrics 50 years ago, emphasizes the value of gooddescriptive contributions to the medical literature in the recognition and management of “new” problems.

Kaessler and Ledgard’s article on a user-friendly procedure for exchange transfusion in erythroblastosis is ad-mirably well written and well illustrated. I personally remember (from the days before overhead warmers and dis-posable kits) the ceremonies of booking the operating room; ordering the blood; unpacking sterilized glass syringes,metal stopcocks, and rubber tubing; heparinizing the entire system; and exchanging the blood into and out of glassbottles. The article by Kaessler and Ledgard is an exceptionally clear explanation of the procedure and was proba-bly useful for community practitioners and for training residents in the performance of exchange transfusions. Themost important mechanical/technical and physiologic complications of the procedure are thoughtfully anticipated,and ways to prevent or deal with those complications are succinctly described.

Interestingly, the authors do not specify bilirubin levels for exchange transfusions, probably because the prospec-tive approach to exchange transfusion advocated by Diamond and associates was not yet generally known nor uni-versally accepted. Neither do they indicate the number of patients treated or their success with this approach, butthey appear to have had extensive experience in managing Rh erythroblastosis. Without any statistics and with alimited bibliography, they provide useful instructions to the careful reader. “How to” articles of this sort still have auseful place in the pediatric literature, as the editors of The Journal recognized 50 years ago. However, in our cur-rent climate of statistical sophistication and rapid communication of techniques and technology, this type of usefulinstruction on a widely practiced procedure might receive less notice from editors and readers.

William J. Cashore, MDDepartment of Pediatrics

Women & Infants Hospital of Rhode IslandProvidence, RI 02905

9/37/118749doi:10.1067/mpd.2001.118749