London's Pulse: Medical Officer of Health reports 1848-1972

View report page

London County Council 1950

[Report of the Medical Officer of Health for London County Council]

This page requires JavaScript

51
length of the gestation period : under 32 weeks the chance of survival is poor and 7
of these immature babies died before their removal to hospital could be arranged.

Most of them were 2 lb. or less and not really viable.

SurvivedDied
HospitalHomeHospitalHome
Under 3½ lb.less than 32 weeks2107
32-36 weeks63
Over 36 weeks1
lb.less than 32 weeks2131
32-36 weeks1253
Over 36 weeks19171
4½-5 lb.less than 32 weeks2
32-36 weeks6162
Over 36 weeks115714
61962015

Of 316 babies of all weights nursed at home, 16 died within the first month, a neonatal
mortality rate of 50 per 1,000. As post-mortem examinations were not always
obtained the causes of death cannot be regarded as strictly accurate. Seven were very
small immature babies who only survived for minutes or at most an hour or two.
The causes of death in the remainder were :—
Birth weights 3½ to 4½ lb. 1 asphyxia 15th day
1 bronchitis 25th day
Birth weights 4½ to 5 lb. 2 pneumonia 8th day
1 cerebral haemorrhage 5th day
1 cerebral oedema 9th day
1 gastro-enterit-is 19th day
1 congenital heart 4th day
Birth weights over 5 lb. 1 "prematurity" 5th day
In these 9 cases the infants appeared to make satisfactory progress at first and then
suddenly became cyanosed, and either died within a few hours at home or shortly after
removal to hospital.
Of the 100 infants transferred to hospital within 12 hours of birth, 25 died,
a neo-natal mortality rate of 250 per 1,000. Considering that few of those removed
to hospital exceeded 4i lb. this result may be regarded as not unsatisfactorv.
Congenital
abnormalities
In only four of these babies were there obvious congenital abnormalities and
apart from one case of congenital heart disease, all survived the first month. This
is not an abnormal experience and congenital abnormality does not appear to be a
cause of premature birth.
Summary
Provided that housing and social conditions reach a reasonable standard,
babies over 4 lb. and not more than 6 weeks premature can be satisfactorily nursed at
home, and breast feeding is established in nearly all cases without any difficulty.
The smaller and more immature infants have a better chance of survival in a special
premature baby unit ; their transfer should be arranged as early as possible.
Out of a total of 416 babies, 375 made satisfactory progress for 28 days or until
their discharge by the midwife or hospital. This excellent result reflects great credit
on the care given by the midwives and doctors in the patients' homes and in the
hospital premature babies' units.
Specialist clinics
Progress was made in the discussions with the metropolitan regional hospital
boards with a view to their taking over full responsibility for the administration of
gynaecological clinics and providing and paying specialists for consultative infant