Profiles in Nursing
Evelyn Lundeen, Challenging Notions About Premature Infants
Some of her ideas, such as requiring mothers to breastfeed, were revolutionary for the time.
Doesn’t the sun always seem to help premature infants? Perhaps that jaundiced baby would do better over by the window. Maybe just a drop of brandy would help settle this agitated baby. Such were the instincts of Evelyn Lundeen, supervising nurse of the premature nursery at Chicago’s Michael Reese Hospital. Since she ruled with an iron hand, these suggestions were doubtless carried out quickly.
But hunches were not the only sources of protocol. She also believed strongly in the scientific method. In the 38 years she governed the nursery, its nurses were involved in many organized studies — on anemia, oxygen control and neurological outcomes, among others.
Shortly after graduating from the School of Nursing at Lutheran Hospital in Moline, Illinois, in 1922, she and Julius Hess, MD, the father of neonatology, set up their infant care program. At that time premature infants were not the main interest of the physicians. They believed, with some justification, that lavishing care on such babies was a futile waste of resources. No one distinguished between low birth weight children, sick newborns, and the preemie. Solid research was still in the future, and statistical reports were unreliable. Incubators, with their tiny inhabitants, were popular at World Fair Expositions; the crowds paid pennies to stare.
Along with Dr. Hess, Evelyn Lundeen challenged the prevailing notions. They established, with empirical evidence, that these tiny babies had three vital needs: maintenance of body temperature, adequate nutrition, and prevention of infection. They organized the nursery around these three objectives, and under Ms. Lundeen, no one interfered, not residents, not attendings, and certainly not parents. Specially trained nurses gave all care, functioning much like today’s advance practice nurses. Woe to the doctor who tried to write orders!
An added feature of care was the insistence on the use of mother’s breast milk for every child. If a mother could not supply the milk, a wet nurse stepped in. To prevent aspiration pneumonia in infants too weak to suck, Lundeen delayed feeding, using instead injections of saline. Nurses fed the weakest with a dropper or by gavage.
Her discharge planning was especially effective, and at the time, innovative. By insisting that mothers supply breast milk and by allowing them entrance to her fortress to nurse when the baby was strong enough, Ms. Lundeen learned which infants would need special formula sent home. Parents were educated, the home prepared, and visiting nurse supervision maintained. Evelyn Lundeen did not allow progress, once gained, to be lost!
So successful was the nursery that students came from all over the country to study firsthand the principles of care: precise feeding, incubator use, minimal handling, and most of all, strict sterility. Nurse Lundeen’s methods became the standard of practice nationwide. She wrote multiple articles and co-authored two widely read texts, The Premature Infant: Medical and Nursing Care, with Dr. Hess in 1958, and Care of the Premature Infant, in the same year, with F. H. Kunstadter.
Many of her methods, like that drop of brandy, are now outdated; but she enjoyed remarkable success in an era with minimal technology, when kernicterus was a mystery and nurses mere handmaidens. Having never married, the nursery was her life’s work. When she died from heart failure in 1963, she was considered the pioneer neonatal nurse.
Elizabeth Hanink, RN, BSN, PHN, is a freelance writer with extensive hospital and community based nursing.