Breast feeding and acute lower respiratory infection.

The association between breast feeding and acute lower respiratory infection (ALRI) was studied in a case-control study in southern Italy. Two groups of children were studied: the first group comprised 73 infants, aged 0-6 months, whose diagnosis was pneumonia or bronchiolitis; the second group included 88 infants less than 12 months of age with a diagnosis of pertussis-like illness. Control infants were two groups of infants admitted to the same ward. Compared with controls, infants in the first group were less likely to have been breast fed (odds ratio 0.42, 95% CI 0.19-0.90). The protection conferred by breast feeding was stronger among infants who were receiving human milk at the time of admission (odds ratio 0.22, 95% CI 0.09-0.55) and was absent among those infants who had stopped breast feeding for two or more weeks before admission. Among infants who were severely ill, breast feeding was less likely than among those with milder illnesses. There was evidence in the stratified analysis of effect modification by the presence of other children in the family. Among the infants with pertussis-like illness, the incidence and duration of breast feeding were not different compared with controls. The results suggest that breast feeding has a strong protective effect against ALRI in industrialized countries also. No protection seems to be conferred by human milk against pertussis-like illness.

Usefulness of neonatal eosinophil counts as a marker of atopy?

Eosinophil count (EC) were obtained from 312 newborns with and 172 without family history of atopy (FHA). The EC were higher in infants with than without FHA. Elevated EC were recorded in babies of parietaria sensitive mothers born in the spring, as compared to other seasons. The predictive value of EC with regard to development of atopic diseases up to 18 months of age was prospectively studied in 103 newborns with FHA. Using 5 x 10(8) cells/l as cut-off level the predictive allergy value was 41%. Elevated EC appears to be a marker of atopy in newborns.

Breast-feeding and urinary tract infection.

A case-control study was conducted to study the association between breast-feeding and urinary tract infection. Case patients were 128 infants aged birth to 6 months with urinary tract infection. Control infants were 128 infants admitted to the same ward with an acute illness. The results support the hypothesis that breast-feeding protects infants against urinary tract infection.

Perinatal mortality in southern Italy.

Perinatal deaths occurring in the Campania region of southern Italy in 1982 were analysed. The perinatal mortality rate was 17.6 per thousand (stillbirth rate 8.3, early neonatal mortality rate 9.3). Compared with Swedish data, our deaths excess does not seem attributable to an unfavourable birthweight distribution, but to high birthweight mortality rates in every birthweight category and particularly in the normal birthweight group (greater than 2500 g). This group of newborns, representing about 94% of the births, contributes 45.4% of perinatal deaths; this situation is not common in developed countries, where the normal birthweight newborns form a much smaller proportion of perinatal deaths. The analysis of the causes of perinatal mortality, even though autopsies are rarely executed in Campania, shows a high prevalence of events which should be prevented by good antenatal and perinatal care.

Antenatal and perinatal care in southern Italy. I. The mothers' reports.

A population-based cross-sectional study of antenatal and perinatal care was performed in Campania, a region of southern Italy. One thousand three hundred women who had given birth in 1982 were interviewed. The number of antenatal visits was very low, less than 1% of the mothers having attended more than three times during pregnancy. The women at high obstetric risk did not attend more than those at low risk and certain aspects of their antenatal care were unsatisfactory. The place of birth was similar for high risk and low risk mothers, with 40% delivering in small private facilities (with few neonatal resuscitation facilities and often with inadequate infant transport services). The labour was induced or accelerated in 60% of the mothers. The organisation of perinatal care did not take into account many of the needs of the mothers such as presence of a relative at delivery, ambulation during labour, early relationship with the newborn, rooming-in, or encouragement to breastfeed.

Antenatal and perinatal care in southern Italy. II. The clinicians' reactions.

One hundred obstetricians and 50 paediatricians engaged in public antenatal and perinatal care in southern Italy were interviewed about the provision of care in their facilities: 93% of the obstetricians judged the coverage of the target population to be insufficient and 53% of them considered the use of the risk approach to be unsatisfactory in public clinics. For example, no initiative was taken by 60% of public clinics when a woman at high risk failed to attend a booked antenatal visit. Bed rest during labour was prescribed by 72% of the obstetricians, a supporting relative was admitted to only 18% of the births and routine episiotomy was performed in 77% of primigravidae. Only 56% of the paediatricians interviewed allowed early contact between mother and baby. In public hospitals, 80% of paediatricians were present in the delivery room for the births. Screening for congenital hypothyroidism and phenylketonuria was executed in only 37% of the public hospitals. Newborn transport system adequate to national standards was available in only 33% of the hospitals. Antenatal and perinatal care need to be rapidly improved to meet population needs in southern Italy.