Neonatal mortality and morbidity / report by a joint committee of the Royal College of Obstetricians and Gynaecologists and the British Paediatric Association.

  • Joint Committee on Neonatal Mortality and Morbidity.
Date:
1949
Catalogue details

Licence: Public Domain Mark

Credit: Neonatal mortality and morbidity / report by a joint committee of the Royal College of Obstetricians and Gynaecologists and the British Paediatric Association. Source: Wellcome Collection.

    7/96 page 5
    - x ~ T. PRELIMINARY CONSIDERATIONS ALTHOUGH it is with the first month of infant life that this report is chiefly concerned, a broader view must be taken if the various problems are to be seen in proper perspective. The neonatal period must be considered in relation to the developmental stages by which it is preceded. Life starts when the ovum is fertilized and then proceeds through an intra- uterine period of progressive foetal development to the expulsion at birth of an infant fully prepared for independent existence. Any influence which adversely affects this foetal development will be reflected in the state of the infant at birth. It is necessary, therefore, to consider the main influences bearing on the early phases of human life. Already at conception the forces of heredity are in action for good or ill. The part played by hereditary influences in the causation of neonatal disease and death is not yet clearly defined. Diseases such as epilepsy, amaurotic family idiocy and acholuric jaundice are usually not manifest until after the newborn period, although they are undoubtedly hereditary. Haemolytic disease of the newborn is of such special importance that it is considered separately (see Chapter IX). According to Haldane (1944) it is responsible for more stillbirths and neonatal deaths than any other inherited condition. Congenital syphilis, although inherited, is not of genetic origin, being due to the direct passage of the infecting organism through the placenta into the foetal circulation. Certain types of foetal malformation (see Chapter V) appear to be hereditary, the familial incidence of harelip and cleft palate, for example, being noteworthy. Gross deformities such as anencephalus and spina bifida may also be hereditary but direct evidence on this subject is difficult to obtain and the chance of affected infants surviving to beget off- spring is remote. There is scope for further research here. Until the influence of heredity is more clearly understood the contribution which eugenics may make to neonatal health cannot be assessed. Immediately after conception, alterations in biophysical or bioclemical activities in the maternal organism may adversely affect the implantation of the ovum and profoundly upset the future development of the foetus, causing miscarriage, stillbirth or congenital abnormality. Once the ovum is healthily implanted, the growing embryo continues to depend on the maternal organism for protection and nutrition and it is clear that the mother’s physical and mental state and her environment, largely directed by economic and social status, play an integral part. The human foetus takes approximately thirty-eight weeks to develop to. maturity and it is of the utmost importance that this full period of intrauterine life should be completed. Premature birth constitutes one of the major factors in neonatal mortality. The birth-process, either at term or before, always involves the foetus in mechanical stresses which are potentially dangerous and which may result in intracranial damage or asphyxia. Directly after birth comes the neonatal period with its problems associated with circulation, respiration, temperature control, digestion, etc., and the risk of exposure to infections against which there is but little natural immunity. Chronologically the chief causes of neonatal mortality and morbidity are congenital malformations, prematurity, birth injury, asphyxia and infections. 5
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