No abstract

Anganwadi worker was involved in rural newborn care as a link between a dai and a health worker. She was trained to ensure that, (i) borderline LBW/preterm baby was kept warm at home and (ii) a very small baby was referred to hospital. The training was conducted during routine monthly meetings and cost of equipping each anganwadi worked out to be Rs 110. Newborn survival, infant survivals and overall MCH performance improved. Thus, newborn care formed an ideal entry point into MCH activities.

In developing countries the need for a risk approach in neonatology is obvious because of a high birth rate, high neonatal mortality rate, and limited availability of resources. Quantification of risk, with selected antepartum, intrapartum factors, clinical, and post-mortem findings was done by calculating odds ratio, attributable risk, and 95 per cent confidence limits in 1811 babies, 541 of which were asphyxiated. Primigravidity, history of perinatal death, pregnancy induced hypertension, and antepartum haemorrhage carried higher risk. Abnormal fetal heart rate and meconium passage in amniotic fluid correctly predicted high risk of birth asphyxia. Decreasing risk in premature/low birth weight babies without increase in abdominal deliveries suggested that caesarean sections were unnecessary in preterm deliveries. Clinical monitoring of asphyxiated newborns was adequate enough.

Determinants of death in newborns admitted to the Intensive Care Unit were studied taking into consideration antenatal history, intrapartum events, and clinical findings. Over 3 years (1984, 1985 and 1986) 1747 admissions were the subjects of this study. Of these, 424 deaths formed the study group and 1323 survivors form the control group. Odds ratio, attributable risk, univariate analysis, multiple stepwise regression, and analysis of variance were obtained. Clinical features associated with respiratory distress, birth asphyxia, admission to nursery after 6 hours of birth, and hypothermia on admission were found to be important factors related to death among nursery admissions.