Causes of early neonatal respiratory distress in the former Venda - a community-based study

Abstract

Objective: To determine in a rural black population the incidence of common forms of respiratory distress (RD) and low birth weight (LBW), the mortality from RD and the perinatal mortality rate (PMR). Design: A prospective study in a context in which about 90% of the community's births take place within the health service and unwell neonates are transferred to hospital. Setting: The Donald Fraser health ward, Northern Province (then Venda), which serves a population of about 180 000 through 21 clinics and health centres and a 450 bed hospital. Subjects: 7 539 infants born alive between 1 February 1992 and 31 January 1993, of whom 48 developed RD. Outcome measures: Hjalmarson's classification of RD, modified for local conditions. Criteria depended on clinical signs, chest radiography, neutrophil count in blood and gastric aspirate, blood cultures and postmortem examination. Results: RD 6.4/1 000 livebirths (95% Cl 4.6 - 8.2); infection 2.6/1 000 livebirths (95% Cl 1.4 - 3.7); hyaline membrane disease (HMD) 0.9/1 000 livebirths (95% Cl 0.2 - , .6); pulmonary maladaptation (transient tachypnoea) 0.8/1 000 livebirths (95% Cl 0.2 - 1.4); mortality from RD 2.1/1 000 livebirths (95% CILl - 3.2); incidence of LBW 7.9% (95% Cl 7.3 - 8.5); PMR 19.8/1 000 livebirths (95% Cl 17-23). Conclusion: A strikingly Jow incidence of neonatal AD in general and of HMD in particular was found in a rural black population, probably related to a low LBW incidence. Infection was the commonest cause of RD.

S Afr Med J 1996; 86; 1413-1<i16