New-onset neonatal pulmonary hypertension associated with a rhinovirus infection.

A 3.5-week-old male neonate who developed an upper and lower respiratory tract rhinovirus infection that was temporally associated with the development of severe pulmonary hypertension is described. Rhinovirus has not previously been associated with pulmonary hypertension. This child developed severe pulmonary hypertension with right ventricular failure, requiring mechanical ventilation, nitric oxide inhalation and, eventually, extracorporeal membrane oxygenation.

The attitudes, experiences and needs of private practioners in the Kingston Metropolitan area in relation to HIV-infected patients - abstract

A questionnaire survey of 83 private practioners in the Kingston Metropolitan area (representing 20 percent of practioners in the area) showed that, in the past 5 years, 51(61 percent) had established 185 doctor-patient relationships with suspected and confirmed HIV/AIDS patients. Only 77 percent of the 108 confirmed cases were reported to the Ministry of Health, suggesting a need to better integrate the private practitioners into the notification system. There was a disparity between the number of practitioners who were willing to do HIV testing (50; 60 percent) and those willing to do the necessary counselling (30; 36 percent). Deep reservations were felt, such that only 24 percent were willing to maintain a therapeutic relationship with an HIV-infected patient. Three of the 4 reservations expressed could be partially alleviated by an educational programme aimed at the private practitioners and their support staff; 75 percent of the practitioners were desirous of a consistent referral system for further care. The establishment of an HIV/AIDS research/treatment centre may answer this need through a supporting role to co-ordinate an islandwide programme for the medical, social and legal management of HIV-infected patients. (AU)

Is routine episiotomy beneficial in the low birth weight delivery?

The outcome of 439 idiopathic singleton low birth weight spontaneous vertex deliveries in the university hospital of a developing country was analyzed. Any patient with a known complication of pregnancy was excluded from the study. The effects of maternal age were minimized by including only those mothers between the age of 17 and 34. The effect of maternal parity was minimized by analyzing the study in two parity groups. The birth weight distributions of the episiotomized and non-episiotomized groups were comparable. There was no significant difference in the Apgar scores and neonatal mortality rates between these neonates delivered with an episiotomy and those without. This was the case, regardless of parity. The value of an episiotomy in the delivery of the low birth weight infant is questioned. (AU)

The contribution of the labour ward midwife in the prevention of low Apgar scores - abstract

The relationship between the workload of the labour ward midwife and neonatal outcome was retrospectively studied over a 3-year period. The Apgar scores were used as an index of neonatal outcome. The ratio of monthly deliveries to the number of midwives assigned to the labour ward for that month was used as an index of workload. There was a total of 8,066 live-births, with an average monthly delivery rate of 227.6. The average number of midwives assigned to the labour ward per month was 13.6. There were 15 midwives/month in the first year of the study as compared with 12 in the third year. As a result, the workload for each midwife increased from 15 deliveries per month in the first year to 18 in the third year. There were, on average, 14 deliveries per midwife each month between January and June and 20 between July and December. Within any particular month, workloads (X) were positively correlated with the proportion of deliveries with Apgar scores of less than 7 at 1 minute (Y = 0.9003 X 10.2034, p < 0.001), and of less than 4 at 5 minutes (Y = 0.1636 X - 0.9683, p < 0.01). Decreasing numbers of midwives (X) were correlated with increasing percentages of deliveries with an Apgar score of less than 7 at 1 minute (Y = 18.0483 - 0.4773 X p < 0.05). Decreasing numbers of midwives (X) were also correlated with increasing percentages of low birth weight infants with an Apgar score of less than 7 at 5 minutes (Y = 27.4813 - 1.1823 X, p < 0.05). It is suggested (1) that more midwives should be assigned to the labour ward during the July - December period, (2) that the work efficacy of midwives should be improved, and (3) that more midwives should be recruited (AU)

Neonatal deaths in the University Hospital of the West Indies - abstract

A retrospective study over the 3-year period 1/10/83 - 30/9/86 showed that the neonatal mortality rate at the University Hospital had risen from 15.8 per 1,000 livebirths, 20 years ago, to 16.6 per 1,000 livebirths at the present time. The birth weight specific neonatal mortality rate for 1,000 - 1,499 gm neonates had risen from 30.1 percent, ten years ago, to 46.6 percent at the present time. The male:female ratio was 1.36:1, with a statistically significant predominance of male neonatal deaths in the 1,500 - 1,999 gm birth weight group. Fifty-nine point seven per cent of the neonatal deaths occurred in the first 24 hours of life. The 5 major causes of death were: respiratory failure 37 percent, neonatal asphyxia (25 percent), congenital anomalies (17 percent), prematurity (15 percent), and neonatal sepsis (7 percent). Over the past 10 - 20 years, deaths from respiratory failure and neonatal asphyxia have gained in importance; while neonatal deaths 20 years ago, to 45 percent at the present time. It is suggested that the prevention of neonatal asphyxia and the provision of an adequate number of experienced neonatology-trained nurses are the basic requirements for any system which attempts to reduce the neonatal mortality rate. It is further suggested that an increase in availability of ventilatory support and other intensive care facilities would help to further reduce the neonatal mortality rate (AU)

Obstetric factors affecting outcome in low birthweight infants

The incidence of low birthweight babies at the Mount Hope Women's Hospital was 3.86 percent. Perinatal mortality was very high in those weighing less than 1,000grams. Above this weight, the presence of ruptured membranes, without chorioamnionitis, was associated with a significantly better foetal salvage than if pre-term labour occurred without rupture of the membranes. The effect was specifically noticeable in babies weighing 1,000-1,499 grams. The commonest associated factor was pre-eclampsia. In these babies, outcome was not significantly better, despite the general claim that infants subjected to intra-uterine stress stand a better chance of survival. Caesarian sections were performed in 17.5 percent of cases, mainly in cases of severe foetal compromise, but this high rate was not associated with improved perinatal outcome (AU)

Colorectal carcinoma in Trinidad - abstract

Colorectal cancer is the fifth commonest cause of death from malignancies in Trinidad. Data available from the Ministry of Health and the Central Statistical Office in the 10-year period 1969-1978 provided 620 cases for analysis. In addition, 152 confirmed cases from the Port-of-Spain General Hospital were reviewed. The mortality rate for cancer of the colon was 4.4 per 100,000 of population with an increasing trend over the 10-year period. The mortality rate for rectal cancer was 1.8 per 100,000 of population with a decreasing trend. The average age of diagnosis was 64.3 years with rapidly rising incidence with advancing age. The M: F ratios are 1 : 1.05 and 1.1 : 1 for cancer of the colon and rectum respectively. There was a higher incidence in the Black, Chinese and Christian communities and a lower incidence in the East Indian, Hindu and Muslim communities. The Chinese had lesions predominantly on the left and the East Indians on the right side of the colon and in the rectum. The negroes had a more even distribution of the lesions. Only 51.6 percent of the lesions were in the rectum and sigmoid colon and 7.4 percent of the cancers were multiple. A relatively high percentage of Stage IV cases (39 percent) was encountered, with a correspondingly low resectability rate (67 percent) and high incidence of intestinal obstruction (29.9 percent). Fortunately, in the later years of the study, more early cancers and less Stage IV lesions had been diagnosed. The increasing incidence of colon cancer demands that a higher index of suspicion with more liberal use of barium enema and sigmoidoscopic examinations be employed in order to make earlier diagnosis and deliver prompt treatment (AU)

Perinatal mortality and breech presentation in Trinidad - abstract

Of 12,698 births at Mount Hope Women's Hospital from January 1983 to December 1984, there were 398 breech deliveries, giving a prevalence of 3.06 percent. Perinatal mortality was assessed in relation to gestatioinal age, birthweight and mode of delivery. The corrected perinatal mortality rate per 1,000 breech presentations was 71.7, compared with 19.9 per 1,000 for the entire hospital population. Perinatal mortality was highest in babies less than 32 weeks' gestation and in those weighing less than 1,500 gm for the gestational age range 28-32 weeks. However, a significantly improved outcome was noted with delivery by Caesarean section for this gestational age group (AU)