Relation of birth spacing with birth weight, morbidity and mortality of the newborn.

PIP: A total of 410 women delivering in the U.I.S.E. Maternity Hospital in Kanpur, India, were included in a study to determine the relation of birth interval with birth weight and infant morbidity and mortality. 66.7% of the sample group had a birth spacing of less than 2 1/2 years, 25.1% between 2 1/2 and 3 1/2 years, and 8.2% above 3 1/2 years. As birth interval increased, so did mean birth weight; mean birth weight was lowest (2150 gm) when spacing was less than 1 year and exhibited an upward trend up to 3 1/2 years. 60.8% of the infants delivered at a birth interval of less than 1 year weighed less than 2000 gm compared with 11.3% of the infants born at birth interval of 3-3 1/2 years. The highest percentages of infant morbidity (52.1%) and mortality (13.1%) were found when birth spacing was less than 1 year; both rates were considerably reduced (20.5% and 2.2%, respectively) when birth spacing was 2 1/2-3 1/2 years. Birth spacing is closely related to effective family planning, and its practice may yield substantial child health benefits.^ieng

Effect of intrauterine growth and gestational maturity of the morbidity and mortality pattern of babies requiring special care.

PIP: In an attempt to reduce infant morbidity and mortality a prospective study looking at intrauterine growth and various infant morbidity and mortality patterns was undertaken in Kanpur. Infants were grouped into preterm small for delivery (SFD) and average for delivery (AFD) and term SFD. Term AFD babies who required special attention were included also. Of 102 preterm SFD 74.5% died while 48.3% of the AFD died. Mortality rates for term AFD and SFD babies were 35.5% and 29% respectively. Hypoxia and infections accounted for 31.4% of preterm SFD mortality and 27.4% of morbidities. Among preterm AFD babies, injections, birth hypoxia and intreranial hemorrhage were the leading cause of morbidity. Hypoglycemia was diagnosed only in SFD newborns. Different mortality patterns were found to be significantly different between preterm AFD and SFD and term AFD and SFD babies. The study indicates that preterm AFD and SFD babies require maximum specialized services.^ieng

Prothrombin time in first week of life with special reference to vitamin K administration.

Prothrombin time was estimated in 100 neonates (80 full term and 20 preterm). Among the full term infants 50 were healthy and 30 sick. Prothrombin time was altered in neonates with birth hypoxia and prematurity (p less than 0.001). Vitamin K administration to anoxic babies resulted in improvement in prothrombin time after 48-72 hours (p less than 0.001). Four newborns has bleeding, 2 had anoxia and 2 were only in preterms who did not receive vitamin K after birth. It is concluded that vitamin K should be given to all preterms and those with difficult deliveries; term, healthy newborns do not need it.

Hepatitis B virus infection and its transmission in preschool children.

In the present study, 2.5% of 367 preschool children has HBsAg positivity. Of 11 mothers who were HBsAg positive during the third trimester of pregnancy, 4 had babies (36.4%) who developed HBsAg positivity by 2.5-3 months of age (vertical transmission). Two babies born of HBsAg negative mothers, with history of jaundice during first trimester, were HBsAg negative. All the relatives of HBsAg positive cases screened were negative for HBsAg.

Poliomyelitis with special reference to immunization status.

One hundred ninety one children below 5 years of age suffering from poliomyelitis were analyzed to find out the immunization status and its correlation with the incidence of poliomyelitis. Effects of age, sex, immunization status and seasonal variation on the morbidity and mortality status were studied. The maximum number of cases were admitted during the months of July (23.6%) and August (23.1%). Of 191 cases, 143 (74.9%) had no immunization and 48 (25.1%) were partially immunized. A total of 155 (81.2%) cases had spinal polio, 23 (12.01%) bulbo-spinal polio, and 13 had (6.8%) bulbar polio. Serious illness (bulbospinal and bulbar type) was more in partially immunized children (25%) as compared to unimmunized children (16.8%). The mortality rate was more than two times higher in the partially immunized (29.6%) as compared to unimmunized children (11.2%). The possible explanation for high mortality in partially immunized children could be due to the adverse effect of OPV which has not been studied so far.

Breastfeeding in babies delivered by cesarean section.

One hundred mothers undergoing cesarean section and their infants were studied regarding various factors affecting the establishment of breastfeeding during their stay in hospital (mean = 11 +/- 3.6 days). Nearly two-thirds (65.7%) of mothers who underwent elective cesarean section, and 62.8% of mothers who received spinal anesthesia were breastfeeding exclusively; while only 53.8% mothers who had undergone an emergency cesarean section and 28.6% who received general anesthesia were exclusively breastfeeding their neonates. All 9 mothers who initiated breastfeeding within 12 h of the surgery were practicing total breastfeeding. In contrast only 5.8% of mothers who initiated breastfeeding after 96 hours, were exclusively breastfeeding their neonates. Total breastfeeding was more frequent (86.8%) in newborn infants who received prelacteal feeds by spoon as compared to those who received by feeding bottle (33.3%). Babies separated from the mothers in hospital were less likely (35.5%) to be on total breastfeeding as compared to those (68.1%) who were not separated from their mothers. This study suggests that for proper establishment of breastfeeding in mothers undergoing cesarean section an elective procedure under spinal anesthesia promotes, early initiation of breastfeeding. Early initiation of breastfeeding has highly significant correlation with establishment of breastfeeding while separation of babies from mothers discourages breastfeeding.