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  • Title: How should very low birthweight babies best be managed in Papua New Guinea?
    Author: Brown N.
    Journal: P N G Med J; 1996 Mar; 39(1):12-5. PubMed ID: 9522845.
    Abstract:
    Short-term outcome in very low birthweight babies has never been closely examined in Papua New Guinea. A cohort of neonates born over a year at Port Moresby General Hospital was followed from birth to death or discharge. Intrauterine growth retardation was an important contributor to low birthweight. Simple, inexpensive care resulted in respectable survival figures. Improving antenatal surveillance will have much more impact in reducing mortality in this group in the future than trying to emulate sophisticated and costly western neonatal care. A cohort of 98 consecutive very-low-birth-weight infants (under 1500 g) born at Port Moresby General Hospital (Papua New Guinea) over a 12-month period was followed from birth until either death or discharge from the Special Care Nursery. The infants were managed with warming, "blind" antibiotic prophylaxis, intravenous fluids, nasopharyngeal oxygen for respiratory distress, and phototherapy and/or exchange transfusion for jaundice. The majority of these infants had intrauterine growth retardation. Mean weekly weight gain was 142 g, while the mean weekly increase in head circumference was 6.46 mm. Overall mortality was 54% and markedly inversely associated with birth weight. The major causes of death were intraventricular hemorrhage (31%), hyaline membrane disease (31%), and septicemia (10%). Since only 40% of discharged infants were returned for review beyond 6 weeks, late outcomes could not be assessed. One-third of infants who were examined after 6 weeks showed signs of subtle or isolated neurodevelopmental delay and there was one case of cerebral palsy. Prevention of very low birth weight depends on attention to intrauterine growth retardation--a result of poor maternal health and nutrition. Recommended are measures such as iron and chloroquine prophylaxis, tetanus toxoid vaccination, and improved nutrition during pregnancy.
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