Nursery neonatal morbidity and mortality in the Philippine General Hospital

Title

Creator

Jongco, Artemio P.

Sevilla-Cabrera, Rosa

Language

English

Source

Volume XV (4) April-June 1959

Year

1958

Subject

Neonatal nursing

Philippine General Hospital

Medicine -- Periodicals

Rights

In Copyright - Educational Use Permitted

Fulltext

NURSERY NEONATAL MORBIDITY AND MORTALITY IN THE PHILIPPINE GENERAL HOSPITAL ARTEMIO P. JONGCO. M.D. and ROSA SEVILLA-CABRERA. M.D. U.P. — P.GJi, Medical Center The importance of maternal health or the immediate en vironment of the fetus which influence the first few days of life cannot be overemphasized. The antenatal growth and de velopment helps in determining the ultimate health of the child. The different maternal factors affecting the fetus during preg nancy and the difficulties it undergoes during birth influence the newborn (1, 2). For this reason, good prenatal care which ensures a healthy environment for the fetus can better assure the optimum growth and development of the latter. MATERIAL The cases studied were the newborn from the nursery of the Philippine General Hospital The average hospital stay of the full term normal babies is 2 to 5 days while those of the abnormal and Cesarean babies is 10 to 12 days. The smaller prematures stayed a little longer but no baby over 30 days of age was included in the series. The aims of antepartal care with regard to the fetus are (a) reduction of prematurity, stillbirth and neonatal mortality rates and (b) optimal health in the newborn <3). The follow ing table shows the neonatal mortality from 1955 to 1958. Table 1. NEONATAL MORTALITY IN THE NURSERY OF THE PHILIPPINE GENERAL HOSPITAL, 196S-19S8 Total Live Births Total Deaths Mortality per 1000 Live BIrtha 1955 1955 1957 1958 7891 8559 8121 8631 372 320 398 389 46.6 374 47.7 45.0 209 210 ACTA HEDICA PHILIPPINA The neonatal mortality rate shown above is much higher than those reported by other workers (3, 4, 5, 6). The next table gives the premature and term neonatal deaths for the years 1956 and 1968. Table 2. NEONATAL DEATHS FOR 1S69 AND 1968 1951 195ft Total Stillbirths 190 239 Total Livebirths 9559 3631 Full Term 7690 3126 Premature 869 505 Neonatal Deaths Fai) Term 57 34 Premature 263 905 Neonatal Death Rate Full Term 0.77? t.0% Premature 30.3% 60.4% An examination of the records of the stillbirths show that majority of the mothers had no adequate prenatal care. Many had only one or at most three consultations in the last trimester of pregnancy while some had none at al). Only those with chronic disease visited their physicians oftener but in many instances were also not adequately managed. In fact, many were malnourished, with nutritional edema, iron deficiency, anemia, vitamin deficiency, hypoproteinemia, dermatosis of all sorts, pulmonary tuberculosis, heart and renal diseases. It can readily be seen that some of these stillbirths could have pos sibly been avoided with more adequate prenatal care (7). PREMATURE DELIVERIES Table 3. MATERNAL FACTORS CONTRIBUTING TO 1954 1955 1957 Toxemia of Pregnancy 81 (29.6%) 75 (23%) 93 (23%) Multiple Pregnancy 47 (17%) 42 (12.9%) 38 (9.4%) Placenta Previa 33 19 43 Premature Labor 10 31 26 Cardiovascular Disease 6 5 12 Abruptio Placenta 5 4 9 Early Rupture of Bag of Waters 6 6 14 Abnormal Presentation of Fetus 10 4 9 P.T.B. & Other Illnesses (Chronic) 6 7 12 Unknown Causes 83 132 147 NEONATAL MORBrniTY AND MORTALITY 2J1 From Table 2, it can also be seen that the death rate in premature infants is 50 to 60 times those of the full term in fants, It can be safely said that if we can reduce prematurity, we will lower infant mortality. It is therefore pertinent to review the different maternal factors that contributed to pre mature deliveries to find out if some of them are preventable. About 23 to 29.5 percent of the premature births were pre cipitated by toxemia of pregnancy. This is rather high because in other countries, toxemia of pregnancy is no longer a frequent contributory factor to prematurity (3). It will also be seen that multiple pregnancy ranks second to toxemia as a contri buting factor to premature delivery. If we can but lower maternal toxemias to prevent premature labor and if we can also prevent premature delivery in multiple pregnancy by early diagnosis so that the patients will accept proper care, then we will reduce neonatal mortality rate in the Philippines. It will be interesting to review the diseases of the newborn to know if some of them can be prevented. Table 4 NEONATAL MORBIDITY FOR 1966 TO 1958 DISEASES 1956 1957 1958 Congenital Pulmonary Atelectasis 51 58 T5 Bronchopneumonia 63 71 64 Aspiration Pneumonia 36 39 16 Pulmonary Hemorrhage 25 19 16 Congenital Malformations 26 20 21 Hyaline Membrane with Resorption Atelectasis 25 19 15 Infectious Diarrhea 14 22 11 Intracranial Hemorrhage 19 26 21 Sclerema Neonatorum 7 14 12 Intra-abdominal Hemorrhage 7 5 2 Omphalitis 6 8 11 Peritonitis 5 2 4 Hemorrhage of the Newborn 6 4 3 Asphyxia Neonatorum 4 5 12 ABO Incompatibility 2 0 0 Brachial Plexus Injury 3 6 Fractures 3 6 6 Conjunctivitis 2 0 3 Suppurative Meningitis 0 1 0 Septicemia 1 0 1 Undiagnosed 11 15 21 212 ACTA MEDICA PHILIPPI NA Table 4 shows a high incidence of infection, a condition that is not only preventable (S), but perhaps even if present can be successfully combated with antibiotics and chemothera peutic agents if recognized and treated early. A fairly good number of the diseases are due to difficulties in delivery. Bet ter judgment and timely intervention by more expert hands will surely prevent many of these accidents (9), and thus re duce neonatal mortality rate. Even the autopsies of 819 newborns in 1956 corroborate the high incidence of infection and trauma. Table a CAUSES OF DEATHS, 1956(10} DISEASES IntenHtul Pneumonia Bronchopneumonia (lobular) Aspiration Pneumonia Hyaline Membrane Pulmonary AtelectaMa Partial Massive Pulmonary Hemorrhage Pulmonary Abscesses Hemothorax Empyema Thoracis Hemorrhage in the Adrenals Kidneys Liver Spleen Intracranial Hemorrhage Congenital Anomalies Cyulupd (1) Anencephaly (1) Horseshoe Kidney (1) Biliary Atresia (1) Intestinal Bands (1) Intestinal Atresia (1> Heart Diseases (2> Ulcers, Stomach Peritonitis Primary (2) Sec. to volvolos (1) Sec. to Diverticulum (1) Number Psrcmt 3 0.94 39 12.23 87 11.60 46 14.42 00 65 17.24 62 10.44 5 1.58 1 0.81 1 0.31 17 6.34 9 2.82 10 3.14 8 0.94 11 8.43 8 2.51 0.62 1.26 NEONATAL MORBIDITY AND MORTALITY 213 DISEASES Omphalitis Infectious Hepatitis Meconium Peritonitis Focal Pancreatitia Erythroblastosis Number Percent 0.(2 0.31 0.31 0.31 0.31 A review of the different causes of deaths easily reveals that about 30% of these was due to infection of some sort Wheth er the infection was contracted prenatally or poatnatally, the fact is, our mortality due to this condition is much higher than those reported from other progressive countries of the world. Some of these infections are not only preventable, but if they cannot be prevented, early diagnosis and proper treatment will save some of these newborn babies. Then, if you add to these infections, the hemorrhages in the brain and other organs which are avoidable in many instances, neonatal mortality rate in the Philippines will significantly go down. BIBLIOGRAPHY 1. WEBSTER, A.; Factors Affecting' Neonatal Mortality, Am. J. Oba. & Gyne., 73:262-272, Feb., 1967, 2. Book Review: Perinatal Mortality in New York City: Responsible Factors, Science, 122:1096, Dec. 2, 1966. 3. LANBETH, S.: Neonatal Mortality in a Small General Hospital, Oba. & Gyne., 3(2):177-188. Feb., 1954. 4. LAB ATE, J., and DICKSON, W.: Prevention of Feta] and Neonatal Deaths, 1961 Med. Cl. of North Am., W. B. Suandera Co., N.Y., pp. 739-748. 5. HASKINS, A., ei al: Cesarean Section at St. Louie Maternity Hospital from 1948-1952, Ara. J. Obs. A Gyne., 70(l>:70-83, July, 1966. 6 ROSS VANT, J.: Studies on Perinatal Mortality in the Prov. of Albertha for the year, 1956-1956, Am. J. Obe. & Gyne., 75(6): 995-1001, May, I960. 7. DONNELLY, J., et al: Parental, Fetal & Environmental Factors in Perinatal Mortality, Am. J? Oba. & Gyne., 74:1245-1256, Dec., 1957. B KEETEL, W. C.: Prophylactic Penicillin Administration in the Preven tion of Perinatal Deaths, Am. J. Obs. & Gyne., 72:2, Aug., 1956. 9. GORDON, C.: Obstetrical Responsibility for the Mortality of the First Day of Life, Am. J. Obs. & Gyne., 70(l):65-69, July, 1955. 10. REYES-AGCAOILt, D.. and DIZON-SANTOS-OCAMPO, P.: Neonatal Mortality in the Nursery of the PCH, Phil. J, Ped. 8{2):Bl-88, April-June, 1959.

pages

209-213

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