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(b) Advice on infant nutrition and hygiene.
(c) Counselling of parents.
(d) Health Education.
(e) Height and weight measurements.
(f) Immunisation and vaccination.
(g) Attachment of H.V.s to group practices of family doctors.
There would appear to be no great dissimilarity between the
services listed and those already being provided.
Whilst maternal mortality has generally declined, its causes have
changed in importance. During the immediate post-war years,
toxaemia was the main cause of maternal death but this has now
been superseded by abortion; pulmonary embolism takes second
place with haemorrhage third and toxaemia fourth. Some anxiety
exists with regard to pulmonary embolism and its possible relationship
with lactation suppression by diethylstilboestrol and a similar
apprehension is discernible with the modern birth control pill. Both
problems are still being subjected to intense investigation.
Illegitimate births continue to increase throughout the country.
In the middle 1930s, on an average, only 4.5% of all live births
were illegitimate but the figure for 1967 was 8.4%, almost double
the pre-war rate. Increased concern is being expressed not only
regarding the fact that one-third of these occurred to girls under
the age of 20 years but also about the accompanying health and
social problems which illegitimacy brings.
Although low birth weight infants form only 7% of all births in
England and Wales, they account for approximately 60% of the
perinatal mortality and, moreover, it is in the surviving low birth
weight infants that most of the physical and mental handicaps are
to be found.
At present it is difficult to establish whether the problems
peculiar to low birth weight infants are due actually to true
prematurity or to reasons connected with retarded foetal growth
over the full gestation period. It is regrettable that the present
method of deciding prematurity, i.e. by birth weight (internationally
agreed at 2,500 grms. or less) is unsatisfactory in determining true
prematurity, viz. those infants who have had a shortened gestation
period. Naturally paediatricians are concerned with both types but
it is necessary to distinguish between these two categories because
their needs and, indeed, their problems are different.
Settling the enigma of prematurity may well open the door to a
solution of the respiratory distress syndrome and the susceptibility
to infection of the true premature infant and, perhaps, lead to some
method of countering hypoglycaemia and the neurological consequences
in the infants with impaired foetal progress.