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5
(a) Neo-natal Mortality
Although there has been a considerable reduction in the infant mortality rate in the last twelve years,
there is still room for improvement. This especially applies to the neo-natal death-rate, which has not been
reduced to the same extent as the infant mortality rate. Whereas, previously, our major efforts in prevention
were concentrated on the children between one month and one year old, while not relaxing our efforts on the
children in this age group, emphasis must now shift to the prevention of death of children under four weeks.
As the report of the Joint Committee of the Royal College of Obstetricians and Gynecologists and the British
Pædiatric Association, 1949, on Neo-Natal Mortality and Morbidity said: "The evidence goes to show that
the present neo-natal mortality and still-birth rates could be reduced by one-third to one-half, and if they were
there would be a saving of about 15,000 babies each year in England and Wales alone." The causes of death
of the 37 babies who died in Willesden during 1948 during the first week of life were:
Prematurity 8
Atelectasis 12
Bronchial Pneumonia 1
Birth Injuries 3
Deformities at Birth 8
Intestinal Obstruction 1
Murder by Strangulation 1
Asphyxia Neonatorum 3
237 premature infants were born in Willesden in 1948, 47 at home and 190 in hospital. Special attention
is paid to these babies by midwives and health visitors in the homes, but home nurses specially trained to care
for premature infants should be provided. There is also need for a special premature unit to be established at
the hospital.
Efficient ante-natal care and good obstetrics are essential to reduce the number of deaths in this age
period. The most important factors are:
(1) Good nutrition of mother.
(2) Education of the mother with regard to pregnancy, labour, breast feeding and the care of the child.
Other factors are:
(1) Improvement of the general social and economic circumstances of the mothers and children.
(2) The prevention of hæmolytic disease due to the Rh. factor.
(3) The provision of anæsthetics and analgesia in midwifery.
(4) The prevention of birth injuries.
(5) The efficient care and handling of the new-born baby and a proper nursing technique adopted on
the part of all midwives.
(6) The prevention of infection in the new-born baby, with special reference to bronchial pneumonia.
(7) The general education and training of the mother.
(8) The provision of hospital beds and paediatricians for the care of premature babies.

Still-births have to be considered in relationship to the neo-natal mortality, for the death of a child
under one week can be considered as a "still-birth which has just managed to survive." Proper and efficient
ante-natal care and obstetrics are important in the prevention of still-births.