When Philip Sunshine, MD, now a professor emeritus of pediatrics, arrived at Stanford as a resident in 1956, neonatology as a medical specialty didn’t exist. Health insurance companies didn’t cover most newborn care. At that time, more than half of premature infants died.
In the ensuing decades, Sunshine built a career that spans the entire history of his academic field. He is now a living legend of neonatology who has used his scientific acumen, clinical expertise and extraordinary talent for collaboration to improve the care of sick and premature newborns everywhere, his colleagues say. He has contributed to some of the biggest advances in the field, including putting newborns with breathing problems on ventilators, welcoming parents to their infants’ bedsides in the neonatal intensive care unit, and bringing obstetric and neonatal care under one roof at Stanford, a change that fostered major advances in maternal-fetal medicine.
“He is one of the most selfless leaders I know. His work was all about putting others forward, always,” said neonatologist Susan Hintz, MD, professor of pediatrics and one of many Stanford Medicine leaders Sunshine helped train. “Phil is a force of nature. It was through his dedication and strength of will that neonatology was built at Stanford.”
Even after Sunshine transitioned to emeritus faculty status in 2001, stepping back from the many leadership roles he held at Stanford, he continued to work as an attending physician in Lucile Packard Children’s Hospital Stanford’s intermediate care nursery. There, he has been beloved by families whose infants graduated from neonatal intensive care and were preparing to go home.
“He’s really down to earth and practical, and he easily gains people’s trust,” said David Stevenson, MD, professor of pediatrics and senior associate dean for maternal and child health, whose talents Sunshine spotted and fostered early. “Families trust him the same way they would trust their father or grandfather.”
Cecele Quaintance, who came to Stanford as a neonatal nurse in 1967 and worked with Sunshine for more than 50 years, said, “There is this deep kindness in Phil — to babies, to us, to everybody. Everybody has the same level of importance to him.” Quaintance’s career at Stanford included a variety of leadership roles, including serving as the first program manager for the California Perinatal Quality Care Collaborative. She considered Sunshine a mentor.
With his trademark cheerful humility, Sunshine, who is retiring this month from providing clinical care through the Johnson Center for Pregnancy and Newborn Services, said he sticks in families’ memories because, “Dr. Sunshine is the easiest name to remember.”
But his colleagues say there’s more to him and his legacy than that.
“I’ve watched families cry when he was going off service because they were so attached to him,” Quaintance said.
Growing the field
After his first year of residency at Stanford, Sunshine was drafted and served two years in the U.S. Navy. When he returned in 1959, the School of Medicine had moved from San Francisco to Palo Alto, and the field of neonatology — named that year — was poised for huge changes. Pioneering neonatologist Lou Gluck, MD, was running Stanford’s newborn nursery, Sunshine recalled.
“He turned me on to caring for newborns and made everything sound so interesting,” Sunshine said.
After completing his training in pediatric gastroenterology, a path he chose because it wasn’t yet possible to formally train as a neonatologist, Sunshine joined Stanford to direct the pediatric gastroenterology program. But advances in infant care kept drawing him to the nurseries. Around this time, a Stanford physician named Joe Daily invented the first apnea monitor to detect when a baby stopped breathing. And in 1962, two other Stanford physicians were among the first in the U.S. to put a newborn who was struggling to breathe on a ventilator.
Sunshine was on the team that refined neonatal ventilation techniques, sometimes by capitalizing on things that went serendipitously wrong with the equipment. For instance, one nursery ventilator had a sticky valve, which provided a longer inspiratory time and more appropriate air pressure. This, the team soon realized, improved the infant’s ability to exchange air and helped babies get better faster.
“This was a very exciting time,” said Sunshine, who took over as Stanford’s director of neonatology in 1967. “People with various backgrounds were bringing their skills to the care of newborns: pulmonologists, cardiologists, people like me who were interested in GI problems of newborns. I picked up a lot of information and enthusiasm from them and we had many opportunities to change how babies were cared for.”
Through the 1960s and 70s, Sunshine developed ways to improve how newborns were fed, focusing his research on the metabolic complications of intravenous feeding of infants. He also diagnosed the first case recognized in the U.S. of ornithine transcarbamylase deficiency, a rare metabolic disorder, and figured out how acute gastroenteritis causes malabsorption of lactose, the sugar in milk.
“He did the original work that helped us design different formulations for infant feeding that we all take for granted today,” Stevenson said.
Parents in the nursery
One important advance emerged through the empathy of nurses for a mother’s worries about her very sick newborn. It was the mid-1960s and parents were not allowed into the hospital nursery. Nevertheless, this mother, whose husband was a Stanford radiology resident, came to the hospital every evening. As her husband completed his patient charts, she “would sit outside the nursery, looking in at her baby,” Sunshine recalled. “It made the nurses very uncomfortable.”
The mother’s longing prompted the medical team to let parents into the nursery, marking the beginning of neonatology’s emphasis on family-centered care.
The Stanford team published the first research on the change, revealing that allowing parents to be with their babies, which parents preferred, did not cause infection rates to increase. Bringing parents into the nursery also shifted the relationships between physicians and nurses. Nurses began noticing, for instance, that families sometimes needed better explanations of medical matters than they received from the doctors. Sunshine helped establish doctor-nurse sessions to talk about how to address such problems.
“The nurses were emboldened to tell us what we were doing wrong,” he said. “It was difficult to understand initially, but it made the physicians and nursing staff bond so tightly, and that has continued throughout my career.”
Key relationships
Sunshine is known for nurturing the careers of other physicians, starting with Stevenson and Ronald Ariagno, MD, now a professor of pediatrics, emeritus, both of whom he hired in the 1970s. The three doctors each took monthlong turns as the nurseries’ attending physician for several years. They were eventually joined by other Sunshine protégés, including Bill Benitz, MD, who is now the Philip Sunshine, MD, Professor in Neonatology, Emeritus; gastroenterologist John Kerner, MD, professor of pediatrics; Bill Rhine, MD, professor of pediatrics; Hintz; and Valerie Chock, MD, associate professor of pediatrics.
As neonatal care advanced, Sunshine traveled to Central California hospitals to hold case conferences to discuss challenges in babies’ care and share best practices. In the process, he developed a network of friendships that evolved into what is now the Mid-Coastal California Perinatal Outreach Program. Its popular academic conference, which Sunshine organized for many years, is still held annually in Monterey, California.
“When we went on transports [to bring sick babies to Stanford], it was very unusual for there not to be someone at the other hospital that we already knew,” Quaintance said.
Back at Stanford, when the Packard family donated money in the mid-1980s to build what is now the West building of Lucile Packard Children’s Hospital Stanford, Sunshine encouraged the planning committee to locate obstetric services and the newborn nurseries in the new facility.
As he described specific needs in one meeting, he said, “Mrs. Packard looked at me and said, ‘How many more beds are you talking about?’ I told her 30 postpartum beds, 18-20 labor and delivery room beds and two units for C-sections. She said, ‘Oh my!’ and I figured, we’re lost.”
But Lucile Packard had recently spent time with her twin newborn grandchildren in the neonatal intensive care unit at Stanford, where Stevenson and Sunshine had cared for them. While there, Packard came to embrace the philosophy of moms and babies being under one roof, so she talked to her husband, David, about increasing their donation.
At a subsequent meeting with then-chair of the Department of Pediatrics Irving Schulman, MD, and the hospital’s architect, Sunshine recalled, “Mrs. Packard said, ‘Tell me about the perinatal unit. We’ve got to do that — keep mothers and babies together.’ They were up until 2 a.m. figuring out how to do this.”
Stevenson, who was also involved in the planning, said, “When Mrs. Packard asked for babies to be cared for in our hospital, all of a sudden everybody was in agreement.” The new building opened in 1991 with the facilities Sunshine had recommended.
Sunshine said resulting close collaboration between obstetrics and neonatology allowed the teams to advance care for extremely complex pregnancies and fostered advances in maternal-fetal medicine, a specialty in which Stanford still leads the nation.
Stevenson and Sunshine also were the original editors of Fetal and Neonatal Brain Injury, the first comprehensive text on the topic.
Sunshine, Hintz said, has been especially adept at recruiting “big names” to contribute to the textbook, which first published in 1989 and is now in its fifth edition. “He had a vision for how this could come together to create a unique and valuable text, and so many people love Phil Sunshine that nobody can say no to him.”
Leading with kindness
But Sunshine’s kindness is what most stands out for Hintz, who described him as the “moral compass of neonatology” for his ability to communicate honestly with families about a child’s health, regardless of whether the news is challenging, encouraging or a mix.
“One phrase I have heard Phil utter for years, when we’re all in the weeds, questioning this measurement or that lab, is to say, ‘Step back. What is the best path for the baby and family?’” she said.
The kindness also extends to colleagues. “My wife still remembers a time I was out of town at a scientific meeting and everyone in our family got sick with vomiting and diarrhea,” Stevenson said. “Phil came over with one of our secretaries and took care of everybody while I tried to find a flight to get home ASAP. That’s the way Phil was — ‘family’ went beyond his own family and included us.”
Sunshine said those connections fed his enthusiasm for the long hours of work at the frontiers of medicine and will sustain him in retirement as he spends more time with his wife, Beth, their five children and nine grandchildren, along with their gigantic network of friends and colleagues. His colleagues across the country have recognized him with such honors as the Virginia Apgar Award, which he received from the American Academy of Pediatrics in 2001, and a Legends of Neonatology award given in 2015.
“I’ve just been so lucky being able to work with really bright people who were enthusiastic, doing wonderful things, and I got credit for it,” he said with a chuckle. Physicians, nurses and “brilliant” Stanford medical students all kept him going.
That, and the satisfaction of knowing how far his field moved. When he started, more than half of premature babies died. Today, more than 90% survive.
“I used to love to get up in the morning and come to work, knowing every day would be a different, exciting day,” he said.
