Management of the infant of the diabetic mother: a self-instructional programme

The objective of this monograph is to assist the medical student and nursing staff in recognising the complications occurring in the infants of the diabetic mother and managing these infants to minimise morbidity and mortality(AU)

Management of the infant of the diabetic mother

The objective of this monograph is to assist the medical student and nursing staff in recognising the complications occurring in the infants of the diabetic mother and managing these infants to minimise morbidity and mortality(AU)

Management of the infant of the diabetic mother: a self-instructional programme

The objective of this monograph is to assist the medical student and nursing staff in recognising the complications occurring in the infants of the diabetic mother and managing these infants to minimise morbidity and mortality

Management of the infant of the diabetic mother

The objective of this monograph is to assist the medical student and nursing staff in recognising the complications occurring in the infants of the diabetic mother and managing these infants to minimise morbidity and mortality

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination

This one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than health comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition. (AU)

Childhood malignancies in Barbados (1985-1989): incidence and survival - abstract

The lack of frequency data on childhood malignancies in the Caribbean prompted this 5-year (1985-1989) retrospective study of childhood malignancy in Barbados. Case finding of malignancies in children <15-years-old attending the Queen Elizabeth Hospital, Barbados was undertaken by reviewing medical and other related records for the period of study. Health statistics for the island were obtained from the Statistics Department of the Ministry of Health. There were 44 cases of childhood malignancy of whom 15 died, representing about 0.3 to 1 per cent of all cancer deaths annually. The average annual incidence of childhood cancer for the 5-year-period was 143.5 per million children. Fourteen types of childhood malignancies were found, and the commonest types were brain tumours (27 per cent) and haematological cancers (27 per cent) (AU)

Profile of teenage mothers and their parents' attitudes to teenage sexuality and pregnancy - abstract

The purpose of this study was to obtain a profile of the Barbadian pregnant teenager and to ascertain from them their parents' attitudes to teenage sexuality and pregnancy. From April 1 to July 31, 1989, information was obtained by questionnaire from 160 teenage mothers during hospitalization. Pregnant teenagers ranged in age from 13 to 19 years, and 131 (82 per cent) were over 16 years, the legal age of consent. All attended, but only 84 per cent completed secondary schooling. They were predominantly of lower socio-economic class and 65 per cent had teenage mothers. Seventy-one per cent lived in homes with no resident male authority, and 54 per cent reported strict parental discipline. Fifty-nine per cent had their first sexual encounter before 16 years of age (legal consent age), only 2 per cent were married and 22 per cent were in commom-law union. Most teenagers (94 per cent) had some knowledge of contraception before becoming pregnant but only 19 per cent practised family planning. Pregnancy was unplanned in 82 per cent and 80 per cent wished to have delayed pregnancy. Sex education was received from school (78 per cent) and mother (33 per cent), but 78 per cent felt it was inadequate. Mothers of pregnant teenagers were mostly single parents (71 per cent), of lower socio-economic class, and 50 per cent were < 40 years of age. Mothers' reaction to the boyfriend were reportedly angry (25 per cent), approving (23 per cent), not angry (15 per cent) and no reaction, (38 per cent). Only 2.5 per cent of teenagers were evicted from the home, and 90 per cent of parents were supportive (AU)

Further seizures following febrile seizure: assessment of risk factors

Retospective evaluation of records pertaining to 316 children admitted to the Queen Elizabeth Hospital for febrile seizures showed a recurrence rate of 24 per cent. Age at onset of first febrile seizure, a positive family history and atypical initial seizure were identified as risk factors for subsequent seizures. Other factors, namely abnormal pregnancy, gestational age, birthweight, neonatal problems and neurological abnormality, did not affect the chances of recurrence (AU)

Outcome of teenage pregnancy at the Queen Elizabeth Hospital, Barbados, January 1983 - December 1985 - abstract

To determine whether the teenage mother and her baby are more prone to complications than the older woman, data were obtained from the Labour Ward and Neonatal Unit admission registers. Twelve thousand, one hundred and seven patients, of whom 2,791 were teenagers, were analysed. Analysis of common medical problems revealed that anaemia (82.7 percent) occurred more frequently in the teenager while diabetes mellitus (16.5 percent) and pre-eclampsia (16.3 percent) were problems encountered more often in the adult patient. The adult mother required more assistance in delivery, Caesarean Sections, (12.4 percent) being higher in this group. The babies of teenage mothers were at a disadvantage in terms of low birth weight and gestational age, lower 1-minute Apgar scores, sepsis and increased neonatal deaths, usually due to prematurity. While the teenage mothers may at present not be at an increased risk with adequate antenatal care, it is important that the offspring are regarded as high-risk neonates and are monitored closely (AU)

Routine investigations in first febrile seizures

Retrospective evaluation of records pertaining to 338 children presenting with a first episode of febrile seizure revealed a high performance rate of routine haemoglobin levels, total white cell and differential count, blood glucose, serum electrolyte and urea levels, lumbar puncture for cerebrospinal fluid examination and blood cultures. Lumbar puncture emerged as the most useful investigation in detecting eight children with meningitis, three of whom were over the age of two years. Transient elevation in blood glucose levels, hyponatraemia and low serum bicarbonate levels were noted in some children but their significance is not known. Routine haemoglobin estimation detected sixteen children with unsuspected anaemia, but the remaining investigations were largely unhelpful (AU)

Feeding practices of infants, and beliefs of mothers in Western Jamaica

An infant feeding survey was carried out in three parishes in Cornwall County, Jamaica, from March to August, 1984, in an attempt to determine the feeding practices of infants and beliefs of mothers in Western Jamaica. Forty-one enumeration districts (EDs) were randomly selected from two strata, urban and rural, in proportion to the population distribution. Six hundred and fourteen households with children under thirty-six months of age were selected from 41 EDs. The results showed that the prevalence of breastfeeding was 98 percent. Despite the high frequency of breastfeeding, infant formula was introduced very early, and only about half the mothers introduced semi-solids and solids within one month of the recommended time. The most popular foods, identified as good foods, were also popular weaning foods. It is concluded that there is need for adequate training of both primary and secondary health-care staff, and reinforcement of the effectiveness of nutrition education programmes is also important (AU)

Current problems of neonatal septicaemia in Barbados - abstract

Neonatal septicaemia is a common cause of mortality and morbidity in the neonatal period, contributing factors being rapidly changing causative organisms and increasing resistance of gram-negative organisms. In this study, current problems of neonatal sepsis at the Queen Elizabeth Hospital were analysed in 227 infants suspected of having sepsis and who were admitted to a neonatal special care unit, during a two year period. There were 134 (59 percent) males and 93 (41 percent) females, a ratio of 1.4:1. Most patients (131 or 61 percent) presented at less than 24 hours of age, the most related obstetric factor being spontaneous vaginal delivery in 162 patients (71 percent). One hundred and twenty-one (50 percent) were low birth weight and 53 percent mothers had ruptured membranes for less than 12 hours. There were 24 deaths, 12 (50 percent) occurring during a Klebsiella epidemic. The mean hospital stay per patient was 12 days. One hundred and sixty-one bacterial isolates were recovered - 47 (29 percent) gram-positive and 114 (71 percent) gram-negative. Staph. albus, Staph. aureus, Klebsiella and E. coli were the most frequent isolates. Bacteriological sensitivity analysis revealed gram-negatives as highly sensitive to gentamycin and tobramycin and gram-positives as highly sensitive to cloxacillin. Proven sepsis was predominantly gram-negative. We recommend practising routine surveillance, aggressive investigation and no change in antibiotic policy at this time.

Neonatal complications of the low birth weight infant at the Queen Elizabeth Hospital, Barbados: November 15, 1981 - November 15, 1983 - abstract

This prospective study was undertaken to determine the incidence of low birth weight babies delivered at the Queen Elizabeth Hospital, as well as to assess the proportions of small and adequate for gestational age, and the neonatal complications seen. During the 2-year period under review, 8,501 babies were delivered. Of these, 4,273 were born in the first year and 4,228 in the second year. Three hundred and sixty-one low birth weight babies were delivered in the first year and 417 in the second year, giving a low birth rate incidence of 8.4 percent and 9.9 percent respectively. Of these, 415 consecutive births were analysed. Two hundred and ninety-five (71.1 percent) were birth weights of 2001-2500 gram; 67 (16.1 percent) were 1501-2000 grams; 30(7.2 percent) were 1001-1500 grams; and 22 (5.3 percent) birth weights were less than 1000 grams. One hundred and fifty of the mothers (36 percent) were primigravida and 265 (64 percent) multipara. Two hundred (48.2 percent) were born to mothers in the 20-29 year age groups; 153 (36.9 percent) in the 16-19 year age group; 50(12.0 percent) in the 30-39 year age group and 7 (1.7 percent) in the over 40 year age group. Two hundred and fifty-three (61 percent) were adequate and 162 (39 percent) were small for gestational age. There were 165 males and 250 females. Thirty-four (8.1 percent) had an Apgar score rating above 7 at 1 minute. Forty (9.6 percent) died. Ninety-five percent died within the first 24 hours. The majority died from severe prematuritiy (50 percent) and respiratory distress (25 percent). The other causes of death were perinatal asphyxia, infection, intracranial haemorrhage, pulmonary haemorrhage and aspiration. Hypothermia, jaundice and respiratory distress were the commonest complications seen in all age groups. Complications were most marked in the 1501-2000 gram group. The low birth weight infants remain at high risk for complications. Infants weighing less than 2000 grams should receive intensive care. Efforts to further decrease the low birth weight incidence should be an obstetrical priority (AU)

Patterns of neonatal respiratory distress in Barbados during 1982 - abstract

Idiopathic respiratory distress syndrome (IRDS), a major cause of neonatal morbidity and mortality, has never been properly documented in Barbados. This prospective study was therefore designed to identify all cases of neonatal respiratory distress occurring during 1982, to determine the commonest causes, and to establish the true incidence and mortality of IRDS at the Queen Elizabeth Hospital. During this period, there were 4,225 live births and 12.5 percent (529/4,225) developed respiratory distress. 52 percent (278/529) had transient tachypnoea, 17.2 percent (91/529) had IRDS, and 12.6 percent (67/529) developed aspiration syndromes. IRDS was diagnosed clinically in 91 neonates by the presence of cyanosis, with intercostal and subcostal retractions, expiratory grunting, and tachypnoea >60/minute, persisting for more than 12 hours, or until death - whichever was the shorter period. Chest X-ray and post-mortem confirmations were obtained where possible. Factors analysed included maternal, type of delivery, 5 minute Apgar score, sex, presence of hypothermia, weight and appropriateness for gestational age, duration of respiratory distress, X-ray changes, complications, and factors associated with mortality. 2.15 percent of total live births (91/4,225) developed IRDS. The low birth weight incidence was 10.84 percent (458/4,225;<2,500grams). The incidence of IRDS in this low birth weight group was 19 percent (87/458). The incidence was inversely proportional to the birth weight. <1000 grams, approx. 62 percent, (10/16); 1,000 - 1499 grams, approx. 55 percent, (23/42); 1,500 - 1999 grams, approx. 37 percent, (38/102); 2,000 - 2499 grams, approx. 5 percent, (16/298); >2500 grams, approx. 0.1 percent, (4/3,767): The mortality associated with IRDS was 18.68 percent (17/91) and represented 25 percent (17/68) of the total neonatal mortality for 1982. Morbidity and mortality were increased in males, and neonates with hypothermia, lower birth weights, severe chest X-ray changes, apnoeic and cyanotic spells, persistency of the feotal circulation and intracranical haemorrhage (AU)

Outcome of diabetic pregnancy in Barbados: 1980-1982 - abstract

This prospective study of 76 cases was undertaken to determine the incidence of complications in the newborn of diabetic mothers; to analyse factors in the mother which may be associated with these, as well as to identify features common in the pre-diabetic phase. Of these 76 cases, 11 (14.5 percent) were primigravida and 65 (85.5 percent) multiparae; 8(10.5 percent)were teenage pregnancies; 55 (72.4 percent) were gestational diabetes and 21 (27.6 percent) overt; 41 (53.9 percent) were controlled on diet alone while 35 (46.1 percent) required medication. Complications associated with pregnancy included pre-eclampsia 3/76 (3.9 percent), hydramnios 1/76 (1.3 percent). The incidence of diabetes was 0.3 percent of total pregnancies in 1980 and 1981, but increased to 1.14 percent in 1982. Delivery was at term in 70 (92 percent) and preterm in 6 (7.9 percent). Caesarean section was performed in 18 (23.7 percent) and 58 (76.3 percent) were delivered by the vaginal route. Thirty-nine (51.3 percent) were large for gestational age (LGP), 34(44.7 percent) adequate (AGA), and 3(4 percent) small for gestational age. Commonest complications seen were jaundice 48(63.2 percent); hypoglycaemia 30 (39.5 percent); jitteriness in 20(26.3 percent), and polycythaemia in 13 (17 percent). Both infection and perinatal asphyxia occurred, each in 8 accounted for only1/76 (1.3 percent). There was 1 stillbirth in 1982 giving a perinatal mortality of 2 percent or 8 percent of the total mortality. Factors identified as significant were positive family history of diabetes 37 (48.7 percent); obesity 35 (46.1 percent); previous large babies 34(44.7 percent) and an obstetric history of stillbirth or spintaneous abortion or neonatal death 22 (28.9 percent). We conclude that the above factors should alert one to the possible eexistenc of the pre-diabetic phase in the pregnant woman. All babies born to diabetic mothers should bo obseved closely during the first 48 hours. Monitoring of blood sugar levels and early recognition and treatment of complications will decrease the high morbidity (AU)