The Health bulletin [serial] - University of North Carolina at Chapel Hill

February, 1955 The Health Bulletin 13the mother, as in eclampsia, furtheradd to the deaths of infants, manydeaths which perhaps are needless andtragic."How Shall They Survive?" AgainI must repeat that a program of salvagemust begin as early in pregnancyas possible. Since contributing factorsto early infant death, even fetal death,have their incipient stages in prenatallife, it is demanding that early andcontinuous supervision be available tothe mother, preferably by a physicianof her own choosing but, in any instance,one available in the community.No program is worth a grain of salt ifit does not provide an adequacy ofcontinuity and follow-up. Constantsupervision and observation allow fora detection of deviations and/or complicationsearly enough to allow forremediable measures to be instituted.Supervision of the newborn must beginimmediately after birth, and, ifconditions are favorable, a completephysical examination is done to ruleout any condition of immediate dangerto the infant. This is then followedby constant medical and nursing observation,regardless of where the deliveryoccurred. Particularly in home deliveriesis it imperative that the publichealth nurse be involved to the extentof postpartal visitation. In this strategicrole the nurse may be the discovererof hazardous abnormalities which werenot evident when the infant was examinedat birth. The nurse, however,must be cautioned to refer her observationsto the family physician firstand through his follow-up efforts thehealth of the infant will be safeguarded.If prematurity, congenital malformationsor birth injury, our universaltriumvirate of killers in the newbornperiod, are not involved when the infantis born, our next compelling duty isthe prevention of infection. Infants donot seek out the lethal organisms.Somewhere a second party is involved,be it through immediate contact or respiratoryspread. It is here that thepublic health nurse plays a majorrole in a program of "How Shall TheySurvive?" Through her efforts the motheris stimulated to maintain earlycare and observation of her child byher physician or through the facilities,where available and indicated, of thelocal health department. She it is whocan ethically and soundly instruct themother in the principles of good nutritionand promote the maintenance ofa clean, safe, sanitary home environment.We must consider, if only briefly,the problem of prematurity. Although,we in public health recognize prematurityas a sign rather than a diagnosis,it is recorded as the greatest killer ofinfants.The premature infant is born saddledwith the threat of death. His immaturitydisturbs many physiological functionsas well as physical, all of whichare not conducive to survival. But wefirmly believe, in fact we know, thatmany prematures can be saved. "HowShall They Survive?" The approachto a program of salvage is a preventiveapproach. Basically, it calls for a soundmaternal health program, continuouslypromoted and maintained. This programmust particularly stress the importanceof nutrition of the pregnantwoman. It must also allow for theobservation, care and, if necessary,treatment of any complications attendantto the pregnancy. This must implythe availability of properly equippedand staffed hospitals where the propermanagement of a premature deliverywill go a long way toward insuring themaintenance of life.As in a program of maternal survival,the acceptance of hospital standardsas guides in infant care will insurea marked decrease in needlessdeaths. These standards must emphasizedesirable and recommended medicalprocedures and should serve as abaseline for hospital policy.What can we do to promote the survivalof the older infant, the preschooler,the school-age child?In a report of the Committee forthe Study of Child Health Services,American Academy of Pediatrics, 1949,we read the following: