Acute respiratory disorders in the newborn: a survey at the Mt. Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital [MHWH] from January 1st to December 31st, 1994. The study also examined the relationships between incidence rates and maternal and neonatal parameters. Hyaline membrane disease (HMD)m trabsuebt tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), persistent foetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5,062 live newborns using standard diagnostic criteria. Overall, 174/5,062 neonates were diagnosed with ARD to give an incidence of 3.4 percent (104 males and 70 females). The commonest ARD was PI (39 percent) followed by HMD (48/4363) in full term neonates. HMD occurred mainly in the preterm and low birth weight babies. TTN and PI were found in all gestational age groups. Asphyxia was present in 9.8 percent (17/174) at 1 minute and in 10.9 percent (19/174) at 5 minutes. It was more common in babies who developed HMD and PFC. Forty one percent of babies with ARD required assisted ventilation. There were 58 (33 percent) deaths. More than one half of those ventilated died (55 percent), 2/3 of those with asphyxia at both 1 and 5 minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs.

Breastfeeding management

This review was done as a ready guide for the practicing health worker to support and promote breastfeeding. A lot of specific data on breastfeeding are available but these are scattered and sometimes inaccessible. The goal of this review is to provide practical information for the management of the individual mother and infant

Perinatal implications of meconium stained liquor

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital(MHWH), Trinidad, during the period January 1 to December 31, 1991.The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium staining of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analysed using EPI-INFO software programme. Meconium staining of the amniotic fluid was present in 336 live births, giving a prevalence of 6.2 percent of live births which is low compared to values reported in other studies. There was no significant ethnic differences among women who had MSL and 81.3 percent were aged <32 years within a mean of 26.4 years. The majority were primiparous (46.4 percent) and 97 percent had antenatal care. The 3 commonest maternal problems in the 336 women with MSL were foetal distress(23.9 percent), hypertension in pregnancy(14.9 percent) and postdatism (10.4 percent). Birth weight of babies ranged from 1,040 4,960g with a mean of 3,258g, 8 percent were <2,500g and 9.8 percent were >/_4,000g. 86.3 percent were term 10.7 percent were post-term and 3.0 percent were preterm. One and 5 minute Apgar scores of <7 percent were found in 45.5 percent and 12.2 percent of babies, respectively. Neonatal problems were encountered in 146/336 neonates (43.8 percent) and respiratory distress was the commonest (72 or 49.3 percent). Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (4.5 percent) to give an incidence of 2.8/1000 live births and was associated only with the presence of old and thick meconium in the amniotic fluid. There were 6 (40 percent) deaths among the 15 with MAS. These findings clearly indicated the need for improvement in the delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment