A four year study on neonatal morbidity in a New Delhi hospital.

The neonatal morbidity was studied in 7015 neonates born at the All India Institute of Medical Sciences Hospital, New Delhi. The incidence of low birth weight babies was 26.7 per cent; one seventh (13.5%) of the series were preterm (less than 37 wk), while 6.6 per cent were 'small-for-dates'. Birth asphyxia of varying severity developed in 5.9 per cent infants. Respiratory distress syndrome was diagnosed in 5.7 per 100 live-births; most being due to hyaline membrane disease (33.5%), which affected 14.1 per cent of preterm babies. Neonatal hyperbilirubinemia occurred in 5.9 per cent, most of whom were premature. In nearly one-fifth, the cause of jaundice could not be identified after detailed investigations. Minor bacterial infections (conjunctivitis, pyoderma, oral thrush, umbilical sepsis) were observed in 1.8 per cent while major infections (septicemia, meningitis, diarrhoea) in 3.0 per cent. The overall incidence of major malformations was 2.3 per cent. Reasons for low incidence of bacterial infections and common occurrence of hyaline membrane disease in premature infants, are highlighted.

Perinatal & neonatal mortality in a hospital.

A total of 7109 consecutive births were studied over four years to assess perinatal and neonatal mortality. The extended perinatal mortality rate was 57 while conventional perinatal mortality rate (PNMR) was 41 per 1000 total births. Perinatal hypoxia (28.7%), immaturity (24.8%), congenital malformations (14.6%) and infections (5.6%) accounted for most perinatal deaths. The ranking of causes of neonatal deaths was immaturity, birth asphyxia, bacterial infections and congenital malformations. Neonatal mortality rate was 31 per 1000 live births and nearly 90 per cent mortality occurred in low birth weight (LBW) neonates. Hyaline membrane disease accounted for 13.4 per cent of early neonatal deaths. The case fatality rate among LBW babies and preterm babies was 10 per cent and 20 per cent respectively. There is a need to identify strategies to reduce the incidence of prematurity and LBW babies. Comprehensive antenatal coverage and adequate care followed by optimal management of infants at birth is likely to reduce PNMR and improve quality of life among the survivors.

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis.

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1-11 years age-group. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/1000 children born in 1974-76, 7.7/1000 children born in 1977-1980 and 2.3/1000 children born in 1981-1984 (expected to increase to 3.1/1000 when all children born in 1981-84 cross 5th year of life). Immunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974-80 when immunisation was a clinic based activity. Coverage increased from 50 to 80% during 1981-85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.

Lessons from improved neonatal survival at Chandigarh.

We observed a significant fall in neonatal mortality in babies weighing less than 2 kg during 1986 as compared to 1973 (7.94% vs 12.88%; p less than 0.005), and in preterm babies the mortality fell from 26.88 to 11.5% (p less than 0.001) during 1986. This was achieved despite 2-3 fold increase in the high risk babies and without any increase in the number of neonatal special care beds or nurses. Effective utilisation of the facilities was made possible through: (a) reduction in admissions to neonatal special care unit of babies with birth weight more than 1500 g; (b) early discharge of babies to home from NSCU; (c) involvement of the mothers in the care of their high risk babies: and (d) care of babies with sucking difficulties and asymptomatic birth asphyxia outside NSCU. All babies discharged home at less than 2 kg weight, and living in Chandigarh were followed for 3 months and 98.2% were doing well. This observation highlights the judicious use of neonatal special care facilities and mothers for the care of high risk neonates.