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54
Neo-natal deaths
24 infants died within 28 days, 7 at home and 17 in hospital. 10 deaths occurred
within the first 12 hours, the remaining 14 within 28 days. 13 deaths were in infants
of less than 32 weeks gestation and under 3½ lbs., several of which were not really
viable. In the majority no cause of death was found other than prematurity. Two
infants died from cerebral haemorrhage at 1 day and 28 days respectively, and one
from pneumonia at 7 days. Four had congenital malformations.
Comments
It is evident that the chance of survival depends on the period of gestation as
much as on the weight. Only two infants of less than 32 weeks gestation and under
3½ lbs. in weight survived. These were twins who were removed to hospital immediately
after birth and made excellent progress in a premature-baby unit. Ten
infants of 32-36 weeks gestation and under 3½ lbs. survived, nine in hospital and one
at home. Where the gestation period is over 36 weeks and the weight 4½ lbs. or more,
the baby can be adequately nursed in its own home by the domiciliary midwife.
Out of 190 infants in this group only three died (2 from cerebral hæmorrhage and 1
from pneumonia), the rest were making good progress when discharged by the
midwife.
Maternity and child welfare services
provided by hospitals
The Council runs a child welfare clinic, as a municipal centre, in the premises of
two teaching hospitals. To provide teaching facilities, a member of the hospital
medical staff conducts the sessions, but as the Council may not pay specialist rates
for work of this nature, only the non-specialist rate is paid, the balance being made
up, if necessary, by the medical school.
By arrangement with four teaching hospitals, their medical schools, acting as
voluntary bodies grant-aided by the Council, provide child welfare services on its
behalf. The medical schools pay a rent to the hospital authority for the use of the
clinic premises, and also provide and pay all staff except health visiting staff. The
Council reimburses the medical school at the rate of 90 per cent. of the approved netexpenditure,
subject to the payment by the Council of the full non-specialist rate for
the paediatricians conducting the child welfare sessions. The remaining 10 per cent.
of the expenditure, with the balance of any specialist rate paid to the medical staff,
is found by the medical school and is regarded as a fair return for the teaching
facilities at the clinic. Provided the interests of the Council and of the children
for whose welfare it is responsible are safeguarded, the special requirements of the
teaching hospital are preserved, e.g., in such matters as appointment of the medical
staff to conduct the clinics which are attended by medical students. These clinics
are closely associated with the Council's divisional organisation, liaison with each
hospital and medical school being maintained through the appropriate divisional
medical officer.
The same close association has operated for health visiting services required for
the child welfare clinics at hospitals. The Council's health visitors attend the clinics,
where they are under the paediatrician-in-charge, although for the general direction
of their work outside the clinic they remain under the divisional medical officer.
At one clinic, the medical school has continued to employ a health visitor, subject
to the refund of 90 per cent. of her salary by the Council. At this same clinic, the
Council maintains a training school for health visitors, four students being trained
annually. The students receive their practical experience and tutorial instruction at
the hospital, and take systematic lectures at the Royal College of Nursing.
The arrangements whereby the Council's full-time assistant medical officers at
child welfare centres exchange with medical officers working in the children's departments
of certain hospitals have continued, and there has been some expansion
of this exchange system. This system enables the Council's medical officers to keep