Profiles In Nursing

Evelyn Lundeen (1900-1963), Neonatal Nurse Who Redefined Premature Infant Care

Setting the standards for neonatology care

An illustration of the electrical bassinet on the left, and the stainless steel picture of one on the right

When Evelyn Lundeen began the job that would become her life’s work, neonatology as we know it was barely practiced in the U.S. When 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 carnival gimmicks rather than practical medical technology.

Chicago pediatrician and pediatrics professor Julius Hess, M.D., felt differently. Hess had studied the European literature on caring for preemies, which emphasized consistent temperature and isolation from pathogens. He was also friends with Martin Couney, M.D., a physician and impresario responsible for many sideshow exhibitions of babies in incubators.

Inspired, Hess developed his own incubator, 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 graduated from Lutheran Hospital School of Nursing in Moline, Ill.

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It was the beginning of a three-decade professional partnership. Although Hess was probably America’s leading neonatology 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 infection, 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 dramatically 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 milk supply provided by the station’s wet nurses.

Although Lundeen strove to be as rigorous and methodical as possible, her work often relied as much on instinct as science. Formal clinical evidence was still limited, and some things Lundeen recognized from experience, like the fact that exposing babies to sunlight helped to reduce jaundice, weren’t scientifically validated until years later.

Some of Lundeen’s other tricks, like putting drops of whiskey in the patients’ milk to help them sleep or bathing infants in mustard to improve circulation, would get her written up today. However, no one — nurse, parent or doctor — questioned her judgment or her dedication to her tiny charges. Alwin C. Rambar, M.D., a former student of Hess, recalled Lundeen as “an autocrat who knew more about the care of the premature than the doctors did, and woe unto them who dared to write orders.”

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Preemie Programs

By the early ‘30s, public health officials had taken notice of the Premature Infant Station’s effectiveness. In 1935, the county Board of Health passed new rules for preterm births, including mandatory reporting requirements and a new staff of county-funded home health nurses to provide maternal educational and follow-up care. Although those nurses were Cook County employees, they were trained by Evelyn Lundeen and her staff.

Similar premature infant stations soon appeared in other major cities, funded in part by the 1935 Social Security Act. By World War 2, health departments in more than two dozen states had established premature infant care programs. Most followed the “Chicago model” Lundeen and Hess had pioneered.

Lundeen died in 1963, eight years after the death of Julius Hess. Caring for premature infants had become Lundeen’s entire life. She lived in the hospital nurses’ dormitory and never married. Toward the end of her life, her own health problems limited her ability to work, but she remained a fixture of the premature nursery.

A Lifesaving Legacy

When that nursery was founded, the average survival rate for preemies was only about one in five, but Lundeen and her nurses saved more than 70 percent of their patients. The widespread adoption of the techniques and strategies Hess and Lundeen developed saved countless more lives across the U.S. and around the world, reducing infant mortality rates and expanding the range of medical knowledge about premature infants.

William Oh, M.D., who worked with Lundeen as a resident, later remembered her as “a marvelous person” and said she was “the inspiration and the stimulus that made me go into research.” Alvin Rambar called her “the epitome of the devoted nurse.”

PHOTOS ABOVE: The Hess Incubator 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!

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