To the Editor:As each of us walks through life, we meet teachers who give to us new knowledge that we strive to translate into wisdom. On occasion, we meet teachers who not only enlighten but help us make that translation from knowledge to wisdom. Dr deLemos was such a teacher. We, his students, pay this tribute to him, that he gave us both knowledge and wisdom. He taught us neonatal medicine, gave us tools that improved out abilities to practice neonatal medicine, and helped us develop a philosophy of how to care for our patients, their families, and ourselves in times of happiness, stress, and great loss.Dr deLemos left this world a better place. As he told us, his career as a medical resident began at the bedside of a premature baby dying of hyaline membrane disease at Boston Children's Hospital. That baby was Patrick Kennedy, and the world stood by, helpless, as the tragedy unfolded. Dr deLemos' own feeling of helplessness drove him to the research that is now his legacy. Along with a handful of investigators, he introduced neonatal ventilatory support into the routine management of neonatal respiratory failure. He helped define the etiologic mechanisms that contribute to bronchopulmonary dysplasia, and many consider him the father of the safe application of high-frequency ventilation.Though we respect his contributions to neonatal medicine, we also loved him for his willingness to help us grow professionally. He taught us that focus was essential and that clinical medicine requires bedside management. He was intolerant of poor clinical care and “cook-book medicine,” and he would often show up early in the morning or late at night to check on us. He pushed us to be academically productive. He supported us through failed experiments, poor outcomes, and letters of rejection for publications, carefully explaining that adding to scientific knowledge is challenging. He applauded our successes and celebrated with us when we succeeded. He loved debate and the passion of heated discussion. He fostered in each of us a rugged independence and a propensity to challenge conventional wisdom.We also pay tribute to a side of “Dr D” that many of his colleagues never saw. It was his gentle side, most apparent in his work at Camp CAMP. CAMP is a summer refuge and a home away from home for children with special needs. He ensured that even the most medically fragile child could get to CAMP. He helped develop an “ICU area” that would allow children undergoing home ventilation to experience CAMP. He later became the head cook in addition to being “Top Doc.” He sang with the children, helped them swim and canoe, and cried with joy at the end of camp when the parents viewed all the smiling pictures of their children playing in the hill country outside San Antonio, Texas.Dr deLemos taught us to take knowledge, caring, compassion, and understanding and to mold them into that unique quality called wisdom. He asked nothing in return except that we go and do the same. We will miss his physical presence, and yet his spirit and the wisdom he freely gave will be with us the rest of our days. To the Editor:As each of us walks through life, we meet teachers who give to us new knowledge that we strive to translate into wisdom. On occasion, we meet teachers who not only enlighten but help us make that translation from knowledge to wisdom. Dr deLemos was such a teacher. We, his students, pay this tribute to him, that he gave us both knowledge and wisdom. He taught us neonatal medicine, gave us tools that improved out abilities to practice neonatal medicine, and helped us develop a philosophy of how to care for our patients, their families, and ourselves in times of happiness, stress, and great loss.Dr deLemos left this world a better place. As he told us, his career as a medical resident began at the bedside of a premature baby dying of hyaline membrane disease at Boston Children's Hospital. That baby was Patrick Kennedy, and the world stood by, helpless, as the tragedy unfolded. Dr deLemos' own feeling of helplessness drove him to the research that is now his legacy. Along with a handful of investigators, he introduced neonatal ventilatory support into the routine management of neonatal respiratory failure. He helped define the etiologic mechanisms that contribute to bronchopulmonary dysplasia, and many consider him the father of the safe application of high-frequency ventilation.Though we respect his contributions to neonatal medicine, we also loved him for his willingness to help us grow professionally. He taught us that focus was essential and that clinical medicine requires bedside management. He was intolerant of poor clinical care and “cook-book medicine,” and he would often show up early in the morning or late at night to check on us. He pushed us to be academically productive. He supported us through failed experiments, poor outcomes, and letters of rejection for publications, carefully explaining that adding to scientific knowledge is challenging. He applauded our successes and celebrated with us when we succeeded. He loved debate and the passion of heated discussion. He fostered in each of us a rugged independence and a propensity to challenge conventional wisdom.We also pay tribute to a side of “Dr D” that many of his colleagues never saw. It was his gentle side, most apparent in his work at Camp CAMP. CAMP is a summer refuge and a home away from home for children with special needs. He ensured that even the most medically fragile child could get to CAMP. He helped develop an “ICU area” that would allow children undergoing home ventilation to experience CAMP. He later became the head cook in addition to being “Top Doc.” He sang with the children, helped them swim and canoe, and cried with joy at the end of camp when the parents viewed all the smiling pictures of their children playing in the hill country outside San Antonio, Texas.Dr deLemos taught us to take knowledge, caring, compassion, and understanding and to mold them into that unique quality called wisdom. He asked nothing in return except that we go and do the same. We will miss his physical presence, and yet his spirit and the wisdom he freely gave will be with us the rest of our days. As each of us walks through life, we meet teachers who give to us new knowledge that we strive to translate into wisdom. On occasion, we meet teachers who not only enlighten but help us make that translation from knowledge to wisdom. Dr deLemos was such a teacher. We, his students, pay this tribute to him, that he gave us both knowledge and wisdom. He taught us neonatal medicine, gave us tools that improved out abilities to practice neonatal medicine, and helped us develop a philosophy of how to care for our patients, their families, and ourselves in times of happiness, stress, and great loss. Dr deLemos left this world a better place. As he told us, his career as a medical resident began at the bedside of a premature baby dying of hyaline membrane disease at Boston Children's Hospital. That baby was Patrick Kennedy, and the world stood by, helpless, as the tragedy unfolded. Dr deLemos' own feeling of helplessness drove him to the research that is now his legacy. Along with a handful of investigators, he introduced neonatal ventilatory support into the routine management of neonatal respiratory failure. He helped define the etiologic mechanisms that contribute to bronchopulmonary dysplasia, and many consider him the father of the safe application of high-frequency ventilation. Though we respect his contributions to neonatal medicine, we also loved him for his willingness to help us grow professionally. He taught us that focus was essential and that clinical medicine requires bedside management. He was intolerant of poor clinical care and “cook-book medicine,” and he would often show up early in the morning or late at night to check on us. He pushed us to be academically productive. He supported us through failed experiments, poor outcomes, and letters of rejection for publications, carefully explaining that adding to scientific knowledge is challenging. He applauded our successes and celebrated with us when we succeeded. He loved debate and the passion of heated discussion. He fostered in each of us a rugged independence and a propensity to challenge conventional wisdom. We also pay tribute to a side of “Dr D” that many of his colleagues never saw. It was his gentle side, most apparent in his work at Camp CAMP. CAMP is a summer refuge and a home away from home for children with special needs. He ensured that even the most medically fragile child could get to CAMP. He helped develop an “ICU area” that would allow children undergoing home ventilation to experience CAMP. He later became the head cook in addition to being “Top Doc.” He sang with the children, helped them swim and canoe, and cried with joy at the end of camp when the parents viewed all the smiling pictures of their children playing in the hill country outside San Antonio, Texas. Dr deLemos taught us to take knowledge, caring, compassion, and understanding and to mold them into that unique quality called wisdom. He asked nothing in return except that we go and do the same. We will miss his physical presence, and yet his spirit and the wisdom he freely gave will be with us the rest of our days.

The use of high-frequency oscillatory ventilation (HFOV) was evaluated as a rescue intervention in 122 consecutive infants meeting criteria for extracorporeal membrane oxygenation (ECMO). Fifty-three percent responded to HFOV and never required ECMO, 3/65 died. Infants who ultimately required ECMO had lower aortic and pulmonary peak flow velocities, and lower pulmonary acceleration, circumferential fiber shortening and shortening fraction than those who were successfully managed with HFOV. The use of HFOV with an appropriate strategy decreased the need for ECMO in this patient population.

Extracorporeal membrane oxygenation (ECMO) is used in the treatment of reversible pulmonary disease in the newborn. The ECMO program at Wilford Hall USAF Medical Center began in 1985 and to date, 57 patients have been placed on bypass for a mean of 125 hours. The indications for ECMO are severe, prolonged hypoxemia in patients with an estimated mortality of greater than 90% using conventional ventilator support. The major diagnoses in the patients placed on ECMO were meconium aspiration, congenital diaphragmatic hernia, and neonatal sepsis or pneumonia. Overall survival was 79%, or 45 out of 57. The most frequent complications were intracranial hemorrhage as well as hemorrhage from the surgical site. We have found ECMO to be an extremely valuable adjunct in the care of the critically ill newborn and believe it can significantly improve survival in infants with reversible pulmonary disease.