CAUSES OF EARLY NEONATAL RESPIRATORY-DISTRESS IN THE FORMER VENDA - ACOMMUNITY-BASED STUDY

Objective. To determine in a rural black population the incidence of c ommon forms of respiratory distress (RD) and low birth weight (LBW), t he 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 tr ansferred to hospital. Setting. The Donald Fraser health ward, Norther n Province (then Venda), which serves a population of about 180 000 th rough 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 s igns, chest radiography, neutrophil count in blood and gastric aspirat e, blood cultures and postmortem examination. Results. RD 6.4/1 000 li vebirths (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 l ivebirths (95% CI 0.2 - 1.4); modality from RD 2.1/1 000 livebirths (9 5% 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 inciden ce of neonatal RD in general and of HMD in particular was found in a r ural black population, probably related to a low LBW incidence. Infect ion was the commonest cause of RD.