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The editor and publisher are pleased to dedicate this edition of The Lange Clinical Manual of Neonatology commemorating Dr. Doug Cunningham's career in neonatology and his years of editorial service and leadership on this book.

Dr. Cunningham's interest in the care of preterm infants began during his rotation as an intern in the Premature Infant Nursery of San Francisco General Hospital (SFGH; 1965–1966). His attending physician was Dr. June Brady. With much appreciation, he often recalls her great patience and commitment to teaching and her wealth of information for newborn physiology. He passed his first umbilical vein and artery catheters under her watchful eye and guidance.

His internship year coincided with the earliest efforts for intubating and mechanically ventilating preterm infants with ventilators adapted from adult design. Clearly, Dr. Cunningham's premature infant nursery experience at SFGH ignited his career-long fascination with neonatal pulmonology and mechanical ventilation for sick newborn infants.

His interest in neonatology continued throughout his pediatric residency and service at the US Naval Hospital, San Diego (1967–1972). Upon completion of his residency and military service, he entered the newly formed fellowship in neonatology at the University of California, San Diego, under the mentorship of Dr. Louis Gluck (1970–1972). Those were years of clinical advancement with newly designed infant-specific mechanical ventilators, continuous positive airway pressure support, and improved oxygen monitoring. Arterial blood gas studies became routine, and antenatal amniotic fluid studies for fetal lung maturity became a new focal point of collaboration between neonatologists and obstetricians.

Following his fellowship, he received an academic appointment at the University of Kentucky in the Department of Pediatrics with Dr. Jacqueline Noonan as chairperson. She, as the newly appointed chair of pediatrics, was seeking to develop a division of neonatology and to expand newborn care for sick and preterm infants, a service that would reach many underserved communities of the Appalachian counties of eastern Kentucky. Dr. Nirmala Desai, a recent neonatology fellowship graduate from Boston Children's Hospital, joined him. Coupling Dr. Cunningham's University of California, San Diego, experience with that of Dr. Desai's Harvard Boston background, they became a perfect match for advancing neonatal care with Dr. Noonan's support and guidance. In rapid progression over the next 7 years, a neonatology fellowship program was begun. An expansion of the unit for preterm infants from 24 incubators to a new 50-bed capacity neonatal intensive care unit (NICU) was completed, and ambulance and helicopter sick infant transport was inaugurated. Likewise, preterm infant care took on a completely new look as human milk banking came into service, hyperalimentation was used for supplemented nutrition, and mechanical ventilators designed specifically for newborn infants came into regular use.

In 1988, Dr. Cunningham returned to California as a clinical professor with his former mentor Dr. Louis Gluck, then at the University of California, Irvine (UCI). He participated in the expansion of the UCI neonatology program into a multihospital perinatal regional program for 11 neonatal special care units, spanning 5 southern California counties. Throughout his career in the UCI program, Dr. Cunningham was noted for his teaching efforts. He devoted many hours to teaching rounds with medical students, pediatric house staff, and neonatology fellows.

Nearing retirement in 2011, Dr. Cunningham returned to Lexington, Kentucky, and accepted an invitation to also return to the University of Kentucky neonatology program as professor of pediatrics and interim chief of neonatology. An extensive expansion of the program was underway, requiring recruitment of a permanent chief and expanded faculty, fellowship, and support staff—all to accommodate an under-construction 77-bed NICU and regional perinatal program for the eastern counties of the state.

Today, Dr. Cunningham remains as a University of Kentucky professor of pediatrics (part time) and serves as a consultant, lecturer, and mentor for the neonatology fellowship program. He participates regularly as a lecturer for medical students during their pediatric experience. He also serves as a consultant and advisor for the University of Kentucky neonatology residency program for training physician assistants as advanced practice providers in the NICU.


It has been a personal pleasure for me to see Tricia's success as the originator and longtime editor of this manual. First published in 1988 and now in its 8th edition, it has had unprecedented worldwide success as a clinical guide for the care of sick newborn infants.

I recall the very humble beginnings of the manual that began with Tricia's insistence that it would be the work product of her fellowship in neonatology at the University of Kentucky, rather than an assigned research project. I challenged her to think otherwise, but she remained insistent that she could bring about a publishable manual based on the practical aspects of daily infant care rounds at the University of Kentucky. The culmination of the challenge began when she presented me with a set of drafted chapters. I recall reading them with great interest and congratulated her on their concise text and considerably logical format. The concept of creating "On Call Problems" for the new trainees entering the NICU for the first time was a novel concept that has now been widely embraced in the field of medicine since she first promoted the concept as a teaching tool. It remains a core element in this book's wide appeal. But I countered Tricia with yet another challenge: Could a publisher be found? I was more than a bit taken aback by her quick reply, "I have one, Appleton and Lange. It will be a good fit in the Lange Clinical Manual series." Admittedly, I was smitten by her pluck and success. The future of the manual was conceived on the spot. I recall the pleasure of being asked to write some of the early chapters and to join the project as one of the co-editors.

Recently, a mutual friend asked for a retrospective of what most defined my career. I noted 2 opportunities: first, to have been a part of the beginning of neonatal intensive care for sick newborn infants and the expansion of neonatology as a medical discipline, and second, to have been an associate editor in the development and ongoing success of The Lange Clinical Manual of Neonatology.

I often point out to others, with considerable pride, Dr. Tricia Gomella's accomplishments with the manual, which has achieved worldwide distribution and been translated into 12 languages. I have enjoyed the task of helping to identify authors and editing manuscripts from the many contributors of the editions that have followed. In closing, I wish to express my appreciation for your consideration to dedicate the 8th edition of the manual in recognition of my career. My sincerest thank you.

M. Douglas Cunningham, MD
Professor of Pediatrics (part time)
University of Kentucky College of Medicine
Kentucky Children's Hospital
Lexington, Kentucky

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