INTRODUCTION

With the lowering of mortality rates and improved survival, particularly in the smallest infants, it is becoming increasingly apparent that the risk of developing retrolental fibroplasia (RLF) is still a serious problem. This is true even in the most advanced newborn intensive care units where the administration of oxygen is strictly controlled by means of serial measurement of arterial oxygen tension. Indeed, there is evidence that any concentration of oxygen in excess of that in air is associated with the risk of developing RLF. The identification of oxygen as a major factor causing the development of RLF greatly reduced the impetus for additional research in RLF after 1956. However, today we realize there are still many unresolved problems, and the need for further research in this field is essential. There has also been an increase in public discussion of and interest in this disease because of new litigation concerning cases originating as far back as 1949. Patients and physicians are both uncertain about what actually occurred with respect to the evolution of new information concerning the use of oxygen and the development of RLF. To recreate the sequence of events, the Committee on Fetus and Newborn of the American Academy of Pediatrics has endeavored to present the facts largely through the writings of those who participated in the search for a solution to RLF, and to trace the important steps that led to the discovery of the major cause of this puzzling disease. In recreating events, attention has been paid to the historical background of modern premature care (particularly the use of oxygen), the practice of medicine when oxygen was first used on premature infants in the light of current knowledge, and the process of dissemination of new information.