Early maternal-child contact: effects on later behaviour

Fifty normal, healthy, full-term infants were allowed 45 minutes contact with their mothers immediately after birth at Victoria Jubilee Hospital, Kingston, Jamaica. The behavior of these infants and their mothers was compared with matched controls at six and 12 weeks in a hospital follow-up interview. More early-contact mothers solely breast-fed their infants than did control mothers. Early-contact infants were less likely than controls to be restless or crying during the interviews. At 12 weeks, early-contact mothers were more likely than control mothers to rise and follow when their babies were taken from them, gazed more frequently at their infants, and were more likely to vocalise to their infants during the interview. These diferences indicate that early contact promotes a closer relationship between a woman and her infant. Given the importance of breast-feeding as protection against gastro-enteritis and malnutrition, this closer relationship may be especially valuable in developing countries where such diseases are common (AU)

Glucose 6 phosphate dehydrogenase deficiency and neonatal jaundice in Jamaica

Glucose-6- phosphate dehydrogenase (G6PD) deficiency was detected in 16 (60.6 percent) of a group of23 neonates who had unexplained moderate or severe jaundice. This proportion is significantly more than the 9.4 percent expected in Jamaican neonates who are not moderately or severely jaundiced (P<0.003), and significantly more than the 12.6 percent observed or the 21.0 percent expected in older Jamaican children and adults (P<0.003). Phenobarbitone therapy and phototherapy reduced the need for exchange transfusion but this was necessary in eight patients. Two babies developed kernicterus and one died. On the other hand, only two of 21 neonates who were identified as G6PD deficient at birth subsequently became moderately or severely jaundiced, and this could be attributed to other causes in both cases. These findings indicate that apparently spontaneous neonatal juandice is important in infants who have the G6PD A-enzyme. However, the jaundice is probably precipitated by unknown factors to which the G6PD deficient neonate is more susceptible than the infant who is not G6PD deficient. There is also a slightly increased incidence of G6PD deficiency in neonates who develop jaundice because of ABO or Rh(D) iso-immune disease, infection or prematurity (AU)

Respiratory distress syndrome in Jamaica

Respiratory distress syndrome is a major cause of neonatal death but no information exists of its frequency in the West Indies. A total of 434 babies of 28-36 weeks gestation, admitted to the Newborn Nursery at the University Hospital of the West Indies between 1974 - 1976, were studied to determine the frequency and mortality of the disease. Respiratory distress syndrome occurred in 32 percent of these pre-term babies, a figure well within the range of frequency published elsewhere. Overall mortality was 21.6 percent almost twice as high as in more developed centres. Babies were more likely to develop the disease if they were born by Caesarian Section or after prolonged membrane rupture. Conversely, babies were less likely to develop the disease if they were free from axphyxia at birth or if their mothers had pre-eclamptic toxaemia. (AU)

An outbreak of salmonella heidelberg infection in Jamaica

An outbreak of multiple-resistant Salmonella heidelberg infection is described which produced 91 identified cases and 6 deaths over a period of 4 years. The organism was brought into Jamaica from the Bahamas. Spread through the children's wards of the University Hospital of the West Indies occurred rapidly.In part, cross-infection occurred via thermometer holders containing "savlon". A year after the introduction of the organism into Jamaica, this specific strain appeared to develop resistance to trimethoprim and co-trimoxazole (AU)

The size of Jamaican newborns from 27-42 weeks gestation

Birth-weight, vertex-heel length and head circumference were measured in 1,230 new-born infants delivered at the University Hospital of the West Indies and admitted to the New-born Nursery between January, 1974, and December, 1976. Twins, babies with congenital malformations and those of mothers with haemoglobinopathies or diabetes mellitus were excluded, as were those born outside the Hospital. Gestational age, assessed by physical examination differed by two weeks or more from that based on the unconfirmed mentrual history in 35 percent of the babies studied. The patterns of birth-weight at gestational ages based on mentrual history indicated that the menstrual history, when used alone, was not a reliable indicator of gestational age. Data for weight, length, head circumference and weight:length ratio at gestational periods from 27 - 42 weeks as determined by menstrual history confirmed by physical examination are presented. Jamaican babies weighed up to 200 grams less than their North American counter-parts from 32 to 38 weeks of gestation, whereas this difference was not notable at term (AU)

Neonatal death at the University Hospital of the West Indies

Neonatal deaths at U.H.W.I. from 1974 - 77 were analyzed. The neonatal mortality rate over the 4 -year period was 16.87 per 1,000 live-births. Very low birth-weight babies (<1,500 gms.) accounted for 8.89 deaths per 1,000 live-births or 52.6 percent of all deaths even though their numbers were small (152;1.68 percent of total births). The increasing risk of death with decreasing gestational age is quantitated as is the contribution of first day deaths. Autopsy was performed in 78 percent of all neonatal deaths. Agreement between the clinician and the pathologist as to the principal cause of death was achieved in 80 percent of babies dying. The majority of deaths were due to one of 5 conditions: congenital malformations, infection, respiratory distress syndrome, intrapartum hypoxia in very immature babies. There was a tendency for infection to be under-diagnosed. The prevention of death due to infection is clearly the first priority in Jamaica. (AU)

Nursery admission temperature in immature newborns: the effects of birth-arrival interval and asphyxia

The results of a study on 175 immature neonates of less than 37-weeks gestation born at the University Hospital of the West Indies between August, 1973 and March, 1975 and transferred directly from the delivery area to the nursery have been presented. The mean birth weight was 1,766 grams and the mean gestation age 33.4 weeks. The mean admission temperature was 35.2§C (95.4§F) which was significantly related to a long birth-arrival interval, the mean for which was 30.2 minutes. Severe neonatal asphyxia resulted in lower mean admission temperatures in spite of more rapid transfer (AU)

Perinatal mortality in the University Hospital of the West Indies

Perinatal mortality (including late neonatal deaths) in the University Hospital of the West Indies, from July, 1973 to June, 1975, is compared with that reported a decade previously. No improvement in the perinatal mortality rate is observed. (35.1/1,000 in 1963-65; 35.8/1,000 in 1973-75) (AU)

Paramedical assessment of gestational age in the newborn

Two paramedical workers from the Jamaican Youth Service were taught a system of gestational assessment of the newborn. The results, in a series of 43 newborns, indicate that paramedicals can produce results comparable ( ñ one week) to a medical examiner by more than two weeks in only 5 percent of babies examined (AU)

Prognosis for extremely low birth weight babies in Jamaica

The status of 35 children who weighed less than 1,500 grams when born at the University Hospital of the West Indies, Kingston, between 1969 and 1973, was compared with that of 37 matched normal birth weight controls. Follow-up was in February and March, 1975, two to six years after birth. Low birth weight children were socially disadvantaged and physically smaller when compared with controls. No significant physical handicaps were identified. More of the low birth weight children failed to pass a developmental screening test as "normal" (8/35) than controls (2/37). (Xý=4.35,p<0.04). However, only 46 percent of surviving extremely low birth weight babies were examined, and the possibility of handicap in the untraced minority remains (AU)