sands of fragile newborns each year, including babies born prematurely with lungs that are insufficiently developed to sustain independent breathing. Some infants rely on these devices only briefly, but others with chronic health conditions use these life-sustaining devices for years. As shown below in the photographs of older and newer ventilatory support equipment (Figures 1.1 and 1.2), reductions in the size of equipment and other advances now allow many children who rely on these devices to live at home with their families, attend school, and participate in community life.

To cite another example, children who once would have died from congenital heart conditions today survive with the aid of implanted devices such as mechanical heart valves, pacemakers, devices that close holes in the heart, and artificial tubes used to bypass malformed heart valves. The surgical procedures associated with these and other treatments typically require additional sophisticated equipment, including cardiopulmonary bypass systems (heart–lung machines that oxygenate and circulate the blood while the heart is stopped for surgery), devices that provide anesthesia, and equipment that monitors breathing, oxygen levels, and other critical physiologic variables and warns clinicians of impending trouble. Box 1.1 lists examples of life-saving and life-sustaining devices that benefit children.

FIGURE 1.1 Child in iron lung, World Health Organization, c. 1938 (Used with permission of IUPUI University Library Special Collections and Archives).