Causes of early neonatal respiratory distress in the former Venda--a community-based study.

OBJECTIVE

To determine in a rural black population the incidence of common forms of respiratory distress (RD) and low birth weight (LBW), the mortality from RD and the perinatal mortality rate (PMR).

DESIGN

A prospective study in a context in which about 90% of the community's births take place within the health service and unwell neonates are transferred to hospital.

SETTING

The Donald Fraser health ward, Northern Province (then Venda), which serves a population of about 180,000 through 21 clinics and health centres and a 450-bed hospital.

SUBJECTS: 7,539 infants born alive between 1 February 1992 and 31 January 1993, of whom 48 developed RD.

OUTCOME MEASURES: Hjalmarson's classification of RD, modified for local conditions. Criteria depended on clinical signs, chest radiography, neutrophil count in blood and gastric aspirate, blood cultures and postmortem examination.

RESULTS

RD 6.4/1,000 livebirths (95% CI 4.6-8.2); infection 2.6/1,000 livebirths (95% CI 1.4-3.7); hyaline membrane disease (HMD) 0.9/1,000 livebirths (95% CI 0.2-1.6); pulmonary maladaptation (transient tachypnoea) 0.8/1,000 livebirths (95% CI 0.2-1.4); mortality from RD 2.1/1,000 livebirths (95% CI 1.1-3.2); incidence of LBW 7.9% (95% CI 7.3-8.5); PMR 19.8/1,000 livebirths (95% CI 17-23).

CONCLUSION

A strikingly low incidence of neonatal RD in general and of HMD in particular was found in a rural black population, probably related to a low LBW incidence. Infection was the commonest cause of RD.