A child Is born
Arvo Ylppö was born 27th October 1887 in Akaa, as the fifth child out of twelve. Almost every child at that time was delivered at home. Children were not measured and weighted at that time, but Arvo himself estimated himself, at birth that he was a small child with a weight under two kilograms. Relatives had been waiting for him to come to the world because there had been no boys in the house, ”just girls”. Manpower was needed at the farm due to heavy work by hand. The rest of the family spoiled the kid and he got a lot of attention. Arvo was an active boy often teasing his sisters. There were several accidents in Ylppös’ family. One fell from a high tree, and another hit himself with an axe. When things like that happened, Arvo remembered how his mother was worried and sad about her children and the atmosphere was spread around in the house. The medical officer, Kalle Pelkonen, was called to help. At that point, Arvo made his decision about his future career. ”To be able to help my mother I made, already as a child, the decision to study pediatrics so that mother would not have to phone Dr Pelkonen for advice all the time”.
Through itinerant school to elementary school
The quick-witted and imaginative Arvo did not always fulfill the expectations of a nice child. At that time, the conception of how a child should behave was: talk when you are asked to, otherwise do not bother to exaggerate yourself. Because of this, his parents did not dare to send the wild boy to the elementary school in Akaa, which was well-known for its strict teacher. Therefore, Arvo first was sent to an itinerant school in Hämeenkyrö where he was teached the ABC by Ida Maijala. (It has to be said that education for children those years were a big sacrifice for a farmer. His parents, Henriikka and Heikki did not go to school as kids, but as the development of Finland was important to them, they wanted their children, both girls and boys, to get so well educated as they could.) Arvo learned to read very fast, and when he turned seven, he began in elementary school in Akaa. Despite of being a wild boy, Arvo really liked school and to learn. He was a bright kid. When they asked him what he would become, he confidently answered: “I’m going to be a doctor.” He got good grades in everything besides behavior. Out of 10 he got a 9, and at that time it was almost a disaster.
From elementary school to grammar school
After three years in elementary school he understood that if he was going to reach his goal becoming a doctor, he had to go to grammar school to complete the matriculation examination. He went with his father to Tampere to apply for the school. When they arrived, the porter announced that the school is already full. Arvos' father went to the principal H.M.J. Relander which looked at Arvos grades, and the grade for behavior did not please him at all. Mr Relander said that with those grades he could not start in this school. Arvos' father did not give up, so he went to see Hjalmar Schulman, a teacher in nature science at the school and a good hunting companion, who remembered Arvo from carrying partridge preys when they were out hunting. He talked the principal in to at least letting Arvo write the entrance exam, which he did with good grades, and finally he could start studying there. He though came to the conclusion that he really had to change his way of being if he wanted to finish school.
The environment in grammar school was of great value for Arvo, and the students reacted with great respect to the teachers, which he thought was fabulous educators. They learned to honor their country and to use their free-time in many different ways, including sports, spending time in the forest, reading and musical activities. They were also taught to love their home and their country.
The faculty for physics and mathematics
In 1906 Arvo signed up at the faculty for physical and mathematics to study native language, chemistry, physics, nature science and botany, which at that time was required before studying medicine. He graduated in 1907. Swedish he learned in two years by living with and talking to Amanda and Rosa Spåre, two noble ladies.
In 1908 wrote a letter to the well-known German professor in anatomy, Friedrich Merkel, asking him if he could work and study anatomy at the university in Göttingen – he was admitted. The welcoming at the university was very warm. Professor Merkel left a lasting impression in Arvo by teaching him and the other students from Finland himself.
Arvo worked hard, six days a week, and the practical training in anatomy he finished in one and a half months. He returned to Finland in 1909. The stay in Göttingen was short but had consequences for his career and life. He already planned to return to Germany because it was the best country to do research and work as a doctor at that time, not to talk about to imbibe old European culture.
In Christmas time the same year, he finally became bachelor of medicine and studies and work at the clinics in the Universtiy hospital of Helsinki began. Internal medicine was first out and the candidates had much work to do, and they came in contact with many different patients and diseases. The laboratory conditions were primitive and, for example, the candidates themselves had to count the amount of white and red blood cells.
To become experienced, they sometimes had to collect knowledge from other countries. In 1910, there was a wide spread epidemic of cholera in Russia and Arvo and his friend Viljo Rantasalo decided to become familiar with that.
The clinic service went on, and he spent a lot of time observing patients in the surgical hospital in Helsinki. There, he came in contact with the matron and baroness Sophie Mannerheim, whom he had long conversations about public health with. At that time, no one of them would have guessed that many of their shared thoughts one day would become reality.
Research and specializing in pediatrics in Berlin
In 1912, almost all of the work in clinical practice was done in Helsinki. To learn more and to become better, he planned to do some research in Helsinki. Due to different circumstances he ended up in Berlin at the Kaiserin Auguste Victoria Haus clinic where the 33-year old senior physician Leo Langstein worked. Langstein recommended Arvo to do research in infant mortality and the causes of that. The research did not have any outcome at first, but Langstein had confidence in the diligent Arvo and wrote a letter to the university in Finland asking for prolonged time for research. Arvos' plan was, in the beginning, just to use the summer break to do the research, but that time was not enough. Langstein saw that Arvo had a great future in this field and that he was going to obtain many things in the future, and a gift like Arvo had could not be thrown away. In 1913, he got a solid vacancy as a senior resident. Since he was able to live and eat in the hospital, he had more time for research than before. Arvos’ scientific research was to become under the guidance of the talented professor Langstein, his thesis.
23.3.1914 he was declared the licentiate of medicine in Helsinki and only three days after that he got the medical and surgical doctors degree and there after returned to Berlin.
Leo Langstein and his clinic had a decisive impact on Arvos’ career. The thought of becoming a doctor in pediatrics was already born when he was a small boy seeing many children in his family and surroundings suffering from diseases. Also, his short length surely motivated him as he was only 154 centimeter tall. It was natural for him to become observed in social medicine and health care of children, when those subjects were deeply discussed in Germany in the beginning of 19th century. The final choice of career came, of course, inspired by Langstein, and that is of great luck and benefit for the Finnish maternity and infant field as for the social medical field. On the suggestion from Arvo, Duodecim year 1926 called Langstein to become a member of the honor.
Ylppö published three classic monographs in 1919 on the physiology, growth, clinical findings, pathology, mortality, and outcome of premature infants. His observations were based on the study of several hundred premature infants, as well as on about 600 postmortem examinations. His studies included the histopathology of neonatal pulmonary haemorrhage, respiratory distress syndrome, and congenital heart disease. Ylppös research provided the groundwork for the future scientific study of newborn infants and in particular the care and disorders of the premature infant.
Most of all, Ylppö is remembered for his studies on prenatal and postnatal growth which led to the concept of birth weight and length for gestational age. He replaced the philosophy of congenital weaklings with that of premature infants, defined as those with a birth weight of 2500 g or less. Noting great variations in growth he pointed out that even in fetal life one has to deal with infants who may be thin and long or broad and short.
Just before leaving Germany, Ylppö was awarded the Otto Heubner prize in 1920 while the certificate awarded by the director of the Kaiserin Auguste Victoria Haus, Professor Leo Langstein prophesized for him a shining future in the area and hope that through him, many difficult problems in pediatrics could be solved. He had been a prominent help in the clinic, which he said that they could hardly expect to get again. In a rare combination, the clinician, the scientist and the human being in Arvo had brought great benefit to the scientific reputation of the clinic.
Working life in Finland
Ylppö returned to Finland in 1920 as a competent docent and with the practical experience of working in a large and well-equipped children's hospital. He was ready to enter the hospital management.
Ylppös operation of the Children's Castle (1920-1963) and at the country's leading children's hospital, Children's hospital (1925-1957) as a senior physician was an important part of his work in the Finnish children's health and medical benefit. When he was appointed, there were only 200 medical seats for 1.5 million children. He worked determined to change this.
Chief Medical Officer at the Children's Castle
Children's health care development was initialized before Ylppö went to Germany, when Sophie Mannerheim served as head nurse of Helsinki Surgical Hospital and Ylppö as an assistant at the same hospital. These two visionaries had long discussions about the child care in Finland.
While studying in England, Baroness Sophie Mannerheim (1863-1928) visited child care facilities where single mothers were given a place to stay and the ability to manage their fatherless children. She brought this approach to Finland and started to implement it in Kallio, Helsinki during the war in 1918, with economical help from Swedish friends and relatives.
When Ylppö returned from Germany to Finland Sophie Mannerheim immediately asked him immediately to function as a doctor at the Children’s Castle, which had been up and running for two years.
Children's Castle and the Mannerheim League for Child Welfare
When Ylppö started his work as a doctor at Children's Castle, he was also drawn into the voluntary work of persons interested in child welfare activities. In September 1920, he discussed the development of child care with General Mannerheim. The meeting resulted on the establishment of the Mannerheim League for Child Welfare, the same year on October 4.
The Children's Castle was transferred to the Mannerheim League for Child Welfare management in the late 1920s. Arvo Ylppö and Sophie Mannerheim had a minor dispute about the development of the Children’s Castle. Ylppö was of the opinion that helping single mothers and their children would not reduce Finlands high infant and child mortality. He wanted to help all the mothers by taking care of each child, and General Mannerheim took Ylppös side in this matter. Children's Castle started to develop in to a children's hospital and a children's health care professional education center. Single mothers to children, though, was given treatment first.
Already in 1921, Children's Palace treated 50 children and lodged 10 mothers and 15 internal students. In addition to Ylppö and head nurse Toini Leikola, the staff consisted of three nurses, three practical nurses and wet nurses, housekeepers and other servants. The number of children in care increased to 75 by the end of the decade.
Breast milk central
The significant initiative of the Children's Castle was the establishment of the breast milk central in 1931. The center bought leftover milk from feeding mothers, which then was given to premature babies and sick children at the hospital.
The new Children's Castle
In 1925, the Mannerheim League for Child Welfare had consolidated its position, and the hospital began to be too crowded and in need of expanding operations. In this case, it was decided to raise money for the construction of a new Children's Castle.
The collection started with a concert, which was presented by Jean Sibelius composition "Morceau Romantique" for the first time and auctioned out. A ground in Töölö was purchased, and the blasting work began in the late 1930s. The original drawings were made by architect Kaarlo Borg (1888-1939) and the architects Elsi Borg and Olavi Suortta continued finished the work.
The Winter War interrupted the blasting, which was postponed due to spring 1941. Children's Castle returned to the building project in 1945, when the land clearing and drainage work was started.
The realization of the building was possible when substantial contributions to the Finns were given from abroad, and the Finns were inspired to raise funds for the Children's Palace.
In autumn of 1947, the new Children's Palace was up and running. Inauguration was held on the same day, 21.10 as the old Children's Castle was consecrated 27 years before. Care facilities increased from 80 to 150. The completion of the Children's Palace was one of the milestones in the reconstruction of Finland and marked the idea of better times to come.
In the first full year of operation, 1949, 1181 children were treated with a total of 49143 days of therapy. They were mainly from southern Finland, but also from other parts of the country.
The medical leaders remained the same, with Medical Director Ylppö, Agnes Sinervo as director and deputy chiefs Olli Somersalo and Lea Jokelainen. The Trustees were initially Mannerheim League for Child Welfare, and in addition to these, representatives of the municipal authorities who sent patients there, came in 1952.
The prenatal care was transferred in 1949 to be managed by the City of Helsinki as required by law. The new facilities were ideal as they were designed for that. It continued as a training field for nanny and midwifery students.
An additional building was constructed in 1959, where the just started psychological-psychiatric work to help mentally handicapped children could be lodged. It was also home to the only hospital elementary school in Finland, where the students could keep pace with their schooling during their long hospital stay. The extension increased the hospital's number of seats from 30 to 180.
Changes in management
The association had sold a number of beds to municipalities since 1952. The private hospital fees were so high that most of the patients hardly at all would have been able to get care without public support. About ten seats were reserved for children of the capital and the other for children from other municipalities.
Arvo Ylppö was chief physician at Children's Castle until 1963, when Ilkka Väänänen took the lead. Lea Ylppö continued to work in the children's section as chief of the Department of Neurology. In 1967, the hospital and its operations were sold to a base formed by the Helsinki Children's Castle communes. This arrangement was dissolved in 1997, and Children's Palace became part of the current Helsinki University Central Hospital for Children and Adolescents.
Chief Medical Officer at the Children's Hospital
In 1920, Finland was still recovering from a bloody civil war and the new government wanted to belong to the Nordic countries, but was in fact laying behind its neighbors in many ways. Finland was poor and had a low standard of living, a poor health status of children, and the rate of the first year mortality was greater than the neighbors. There were too few hospitals and hospital beds for children. Ylppö set an ambitious goal: he wanted all children to grow to healthy adults and to gain the treatment they needed regardless of residence and family social status. The development of Helsinki children's hospital was one part of this plan.
Ylppö led the operation at Children's Hospital for 32 years. Historical, major changes in Finland reflected in the hospital during this time in many ways: the years of war and peace, booms and recessions, the increased standard of living and education levels, social reforms and the birth of the welfare state.
Analysis of dark figures
The few pediatricians worked in Southern Finland, in major cities, and the pediatrician saw the newborn child only in exceptional cases. Ylppö presented a political program for the Finnish Medical Association in the general meeting of 1924. The presentation came to two conclusions: Helsinki General Hospital children's department had to expand and at least two new training posts for doctors established. Departments for children have to be set up in the largest cities and the directors must be qualified pediatricians.
The aim was not only to develop a children's hospital at the European standard, but Helsinki University Children's Hospital was to be formed as a center that would educate qualified pediatricians providing high-quality care to all the sick children in the country.
Children's Hospital at Tehtaankatu 1924 -1939
The Children's Hospital at Tehtaankatu, built in 1899, had 35 hospital beds in two wards: one for babies, the other for big children. The baby ward treated diarrhea and pneumonia patients in poor condition, as well as neonates and premature infants. Large children's section, in turn, treated patients suffering from infectious diseases, diabetes, kidney disease or neurological diseases. In a separate wooden building at Vuorimiehenkatu, usual childhood diseases such as measles and scarlet fever, whooping cough, diphtheria, etc were treated. The clinic, Medical Director of Nursing and the offices of lecture and pharmaceutical storage was in the third building. The most important change at this time, however, were the labor nurse students and nurses, who were being trained for the Children's Palace.
Hospital equipment level was unbelievably primitive. Stethoscope and thermometer were the only research equipment, which the doctor had access to. Laboratory studies were carried out infrequently and had little relevance for disease detection in patients. Blood tests were rare and were made in internal medicine ward in the hospital, where the patient was transported to the sampling. The first X-ray machine was purchased in 1929. There were a lot of drugs, but most of the available drugs were in fact ineffective.
The only surgical procedure at Children's Hospital was the opening of abscesses, which was very common, and rarely tracheostomy.
Many of the diseases were for the doctors unknown, or they were considered rare. Newborn babies were often sick and died from "congenital weakness".
When the imaging and laboratory studies did not provide information on the various bodies of the abnormal structure or function, it was considered more as a whole disease. Doctors diagnosed the child as mildly or severely ill if the prediction was good or bad.
Since the infant mortality rate was high and the parents were not very hopeful of improvement in terms of their children, they often called on help too late or not at all. As the standard of living began to rise and the people were provided with the right information, attitudes began to change in children's diseases. When the fatalistic way of thinking about childrens death gave way, parents began to seek help. As the railroad improved, the parents were able to seek help for a sick child from very far away.
In-hospital mortality was in 1920 higher than 15 per cent. It fell slowly, but still remained shockingly high throughout the 1930s. The biggest killers were diarrhea, tuberculosis, and pneumonia. One reason for the high mortality rate was the lack of effective drugs and treatments, as treatment for fluid balance. Other was hospital-acquired infections, the diseases were treated without isolation opportunities.
The new hospital building, modern medicine
Professor Wilhelm Pipping had already in 1914 proposed a new, larger children's hospital construction. The First World War and the following Finnish Civil War, however, delayed the construction of hospitals. The country changed when it gained independency.
It was planned to build it in Meilahti close to the University of the common hospital group, which would have their own buildings in a variety of specialized hospitals. The new hospital did not collect funds, so a compromise was to expand the hospital at Tehtaankatu.
Over the 1936-38, they were finally granted the funds, and the architects made drawings for the new hospital. Excavation work started in the autumn of 1940 in the grounds, and the building plan was approved in May 1941. The first patients were taken to the new children's hospital in the summer of 1947. Children's Hospital moved into new facilities and hospital beds, doctors and nurses multiplied. Neonates and premature infants had their own departments as had surgical patients with early stages one department. The spacious laboratories, equipment helped the staff to more accurate diagnosis than in the past. The improvement of medical science meant that the effective assistance could be provided in a completely different scale than in the past. Advanced diagnostics, new treatments and effective medications improved treatment outcomes. Antibiotics were weapons to overcome infections, as was fluid management for children with dehydration: hospital mortality rate decreased by half within a few years.
Also, the world outside the hospital had changed, there were more children in need of medical care. During four years, more than 100 000 children were born which meant that there were more children under the age of 15 than ever before or later. Society's attitudes were also more child-friendly than before the war.
The beginning of prenatal care and decrease of home births meant that childrens structural defects and diseases were found more often already in infancy. The improved transportation after the war made it possible to send a child patient over long distances in Helsinki for special examinations and treatment. Also, the hospital networks in the 1950s brought pediatric patients treatment options close to the home, but it was still developing.
Pediatrics - areas of specialization
New disease groups were fastly defined and studies became more complex, and one pediatrician was no longer able to manage the entire range of children's diseases, a result of that was the breakdown of larger in to smaller-scale specialty areas. That required a special training for authorized physicians and space for their patients. A major change was the fact that the hospital's expanded children's surgical diseases in the area. Many of the special areas competed with each other for scarce resources.
Children's accidents requiring surgical treatment had so far been treated in the surgical hospital's children's ward, where there were no children's doctor posts. Ylppö was convinced during the construction phase that the children's surgical operation was to take place in close cooperation with and in the same house with the children's doctors.
When the Children's Hospital moved to Meilahti, Women's Hospital opened the doors for the first time to pediatricians. This was the beginning of the treating staff and paediatricians important co-operation. New information for treatment in preterm and neonatal blood circulation and respiratory physiology opened up new horizons of this important group of patients, newborns. E. K. Ahvenainen, who had studied in the United States, was the first to bring this new knowledge to Helsinki. He worked for several years as a senior neonatologist and pathologist at the Children's Hospital, even though they could not offer him a permanent post.
During the war, new of therapeutic approaches to congenital heart defects were developed. Previously, sorting out these structural defects was irrelevant, because there was no treatment. When the surgery was developed, the accurate diagnosis became important. The latest information in cardiology was brought to Finland by Bernhard Landtman (1916-1979).
Child psychiatry was another specialty area that did not require their own department, but gradually strongly influenced all departments of the hospital. Eero Valanne, who had studied in the United States, was the first representment of that. He began to work, first as a residency in the early 1950s, and 1958 as the first child psychiatrist. He wanted to help the hospital staff understand the illness and hospitalization of a child is a stressful situation. Many hospital routines became with Valanne more child-friendly. Visitors hours extended, the parents became more involved in the treatment and pain relief was improved.
The most important role, in the later development of the hospital, was played by Niilo Hallman. He brought the modern pediatrics to Finland and soon became Ylppös right hand. Responsibility for patient examination and treatment and its further development was transferred to a specialist. As Chief Physician, Ylppös task was to manage the whole picture: the Finnish children's doctors graduate training centers, getting training of the highest quality in foreign countries, and to share resources between different specialized functions, without favoring one. His responsibility was to assess whether all the new learning were better than the old ones.
Scientific research and teaching
Ylppö had done pioneering research in Berlin, and when he returned to Finland he tried to continue his own research, but also support his co-workers and subordinates in the field of scientific research. The professor also had to teach specializing Bachelor of Medicine and pediatric diseases Junior Doctors. The teaching was based, above all, on his vast experience and almost unerring doctors eye. He also stressed that parents had to listen to: assess the mother of his children the best mode and for her to believe. As the hospital network increased, almost all of the doctors in the children's departments were trained in the Children’s hospital.
Hospital and outpatient pediatric patients that was treated multiplied. Ylppös tenacious and dedicated work for the hospital activities laid the foundation for the development of the current high level of medical care for children in Finland.
In Children’s hospital, all the workers felt they belong to the same work place, which is responsible for good management for sick children - and co-operation between the various professional groups had to be seamless. Ylppö required a lot from the workers, but at the same time he showed them that their work was appreciated and considered it to be important. The working atmosphere was of crucial importance. Ylppö had the ability to build good personal relationships with a wide variety of people regardless of age, nationality or social status, and the team spirit added various professional get-together activities outside of working hours: common summer excursions, sports activities and festivities.
International research
Arvo Ylppös scientific career contains of a number of exceptional features. It is inspired from a genuine enthusiasm for research, which came to life in the early stages of medical studies..
Ylppö had many related merits as a researcher in a number of neonatology and neonatal illnesses. He explained the terminology and classification of premature, the causes of death in premature babies, premature fatal jaundice disease backgrounds, and treatment of premature infants, as well as put in a change in attitudes towards these young patients, especially in premature infants. Ylppö also showed that organic diseases that occur in premature infants can be prevented and treated and thus improve the prognosis of children. Fatalism changed, and premature infants became patients. Throughout his career, Ylppö maintained an interest in "just born", especially to those who are born abnormally small with many problems and high mortality rate.
Difficult to start a research career
The beginning of the research career was not easy. Despite persistent efforts, Professor Wilhelm Pipping refused to give the student the dissertation topic and to supervise it.
When scientific work could not start in Finland, he turned his attention to Germany. He had spent the early stages of his studies for a few months in Göttingen, deepening his knowledge of anatomy. He knew that at the pediatric research institute, Kaiser Auguste Victoria Haus in Berlin's Charlottenburg-Wilmersdorf, was at advance. It was founded in 1909 and was led by the renowned Professor Leo Langstein (1876-1933). Few people with Bachelor in Medicine would have taken the initiative and had the courage to write such a person and to offer its research work for the summer. However, Ylppö did, and the answer was welcoming.
Aiming for doctoral degree
Ylppös’ study years as a pediatrician and researcher in Berlin are an excellent example of how cutting-edge research even today is born: a talented, ambitious young boy fearless of work, good research environment and supportive management. Professor Langstein took on Ylppö immediately upon arrival in Berlin and followed almost daily the students progress and adaption to the new conditions. The library of the Department and the laboratories were excellent, the only problem was with the laboratory directors sour attitude towards beginners. This was on the other hand replaced by Langsteins strong support, and by Ylppös self-acquired relationships with top-level advisers in Berlin. Among them were Professor of Physical Chemistry, Leonor Michaelis, a physical chemistry pioneer who invented the function of enzymes basic concepts and phenomena, including the well-known Michaelis-Menten constant Km, tools still used in research in the metabolism of the cell biology.
Another important mentor was Hans Fischer and the methods developed to measure bile pigments (bilirubin, biliverdin), which formed the basis for Ylppös thesis. Fischer was, for these qualities, 1930 given the chemistry Nobel Prize. Ylppö was also interested in pathology, and the pathology professor Hans-Dietrich at the neighboring hospital trained him to do autopsies. As time went on, he became responsible for the hospital's own autopsies, and especially detection of diseases and causes of death in premature babies were of heavy weight for his scientific production.
Yellow newborn – what causes it?
Langstein suggested that the theme for his thesis could be bacterial parts in yellow jaundice disease. This is one of the most common problems in the first days of life, which vary in severity from mild skin yellowing to fatal disease. The topic for his thesis later changed to be the bile pigments, bilirubin and biliverdin, the metabolism of the newborn, which required the measurement of blood, urine and faeces. No ready methods existed, so they had to be developed.
New analyzes with more precise tools showed that there were already in the final stage of the fetus measurable levels of bilirubin in the blood and that its concentration increases significantly after birth. If a specific limit of concentration is exceeded, the child appears to get yellow and the diagnosed with jaundice.
After the first week bilirubin levels begin to decline, but in some children yellowness lasts longer. The more difficult cases are connected with a very high bilirubin, as well as the child's tiredness and loss of appetite, and the disease is often fatal. Ylppös interpretation was that the main cause for jaundice was immaturity of the liver, for which reason it leaks the bilirubin to the bloodstream. Ylppös main device, the immaturity of the liver due to the accumulation of bilirubin in the blood, is still accurate.
Who are premature?
Lack of a unified terminology was still a problem in the early 1900s. Clear definitions would therefore be important for research to be disseminated and applied. Some studies had suggested that birth length below 45 cm was a limit value, but Ylppö did not see any benefit in this since the length of the measurement is much more un-precise than that of weighing. Ylppös proposal to define premature, birth weight less than 2 500 g, was gradually to be used in practice, and it is still the criterion for the World Health Organization (WHO). Since the premature prediction strongly depends on the degree of prematurity, it was necessary to classify this group of patients more accurately. Ylppö proposal, the weight of a group of 1 250-2 500 g was given the name Partus praematurus, 600-1 250 g Partus immaturus, and less than 600 g belong to a group of miscarriage. This classification was used for a long time, but the critical care development in recent decades has given a chance of survival even smaller, even less than 500 g for premature babies. Ylppös premature research made him an international authority in this field.
Ylppös study of 20 preterm infants autopsy findings was the most thorough to date. It also contained microscopic results, compared the clinical symptoms with autopsy findings and specifically examined the incidence of bleeding. The main new findings were premature bleeding in the brain. They were particularly common in the smallest preterm infants and not only explained by a difficult childbirth, but also by lack of oxygen during the first day. Subsequent research has shown Ylppös perceptions to be correct, and also freed obstetricians from guilt.
Ylppö also published large-scale clinical studies among the proportion of the causes and prevalence, physiology and treatment of premature infants, as well as their long-term outcomes.
How premature babies grow?
The exact height, weight, head circumference and chest measurements in monitoring premature babies also made Ylppö to a pioneer in the research of growth.
The post-birth studies showed that, especially in premature infants at 6-12 months of age, weight and height growth was slower than in children born at full term, but then a catch-up growth happened, which in most cases resulted in a normal growth at 5-6 years of age. The growth potential of these children followed a normal routine, but was in the early stages disturbed by postnatal diseases and nutritional problems that breast milk alone did not seem to solve. X-ray studies showed that other endocrine disorders also might be slowing down the growth.
Children's acid-base balance
Ylppö wanted to explore the acid-base balance in pediatric patients and show the tendency of increased acidity, also in cases where the pH was normal, by assessing the CO2 compensation rate. As a second measure instrument, he used the curve that describes the binding of oxygen to hemoglobin in relation to the partial pressure of oxygen. Since the effect of acidification of the body also binds hemoglobin and less oxygen is released, the curve therefore moves to a lower level. The extensive research also included a series of urine, faeces and tissue samples for pH measurements.
With these large-scale studies, Ylppö showed that infants, especially premature infants has generally a tendency get too low pH and acidity (acidosis). The same finding also refers to impaired hemoglobin, with the result that the transition of oxygen to tissues is more difficult in such circumstances. Infant's body is at risk to be acidified especially by diarrhea caused by dehydration, and the body gets intoxicated as a result. Also in the hunger state acidosis occurs, especially if cowmilk milk is the child's basic food.
Ylppö also examined the potential treatment of acidosis and wanted to develop an alternative to sodium bicarbonate treatment, which he considered being one side effect. A solution containing phosphate salts, which could be given under the skin when suffering from severe diarrhea intoxication, saved many children's lives.
ArvoYlppös work in Finland for children and pediatrics made good possibilities for the next generation in the field of science, and his name will with no doubt remain among the giants of pediatrics in Finland, Europe and the whole world.
