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To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

This article draws attention to the consequences of severe malnutrition for child survival in developing countries and the international efforts to effectively deal with nutrition problems. Severe malnutrition in developing countries affects an estimated 69 million children under 5 years of age. The most severe form of malnutrition results in marasmus and kwashiorkor and adult growth deficiencies, which affect the ability to work and, for women, the ability to bear normal-weight children. Severely malnourished children, even with treatment, die. The Public Health Nutrition Unit at the London School of Hygiene and Tropical Medicine developed a set of 10 guidelines for the care of severely malnourished children in order to prevent high mortality of malnourished children during treatment. Care varies between the first 1-2 days, days 2-7, and weeks 2-6. During the first several days, the child needs to be stabilized by preventing and treating hypoglycemia, hypothermia, and dehydration. During days 2-7, it is time to treat infections and start cautious feeding. During weeks 2-6, it is time to rebuild wasted tissues and prepare for follow-up. During all three time periods, there is a need to correct the imbalance of electrolytes, correct deficiencies of micronutrients, and provide stimulation and play. Iron supplementation is not provided until the second week. The 1992 International Conference on Nutrition identified the need to develop resources, such as strengthening existing capabilities and improving appropriate training. The WHO and UNICEF initiative on Integrated Management of Child Care uses the treatment guidelines and will be preparing training programs to teach relevant skills for the treatment of childhood illness and malnutrition. Training materials are being developed. The final phase will include the establishment of centers for training in the treatment of severely malnourished children.
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PMID:Reducing mortality rates in severely malnourished children. 1229 76