OXYGEN ADMINISTRATION

OXYGEN ADMINISTRATION

415 SNYDKR and ROSENFELD3 have shown that during intrauterine life respiratory movements are normal and liquor amnii After birth the circulates in the...

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415 SNYDKR and ROSENFELD3 have shown that during intrauterine life respiratory movements are normal and liquor amnii After birth the circulates in the bronchi. in clearing its airvigorous child has no difficulty it feeble one may be impospassages, but in a child or the obstetrician to sible for either the mucus and remove liquor amnii completely, so that the lungs are not fully expanded. MACGREGOR has demonstrated in sections of lung the formation of a " vernix membrane," the vernix becoming plastered to the walls of the alveoli and bronchioles and seriously obstructing the passage of air. Pneumonia rapidly develops in these cases, and the frequently negative results of bacteriological examination suggest that it arises from chemical irritants such as meconium in the liquor amnii rather than from infection. In practice the incidence of asphyxia in newborn babies, with the resultant atelectasis and pneumonia, mainly depends on the care taken to remove liquor amnii and mucus from the respiratory tract after birth and on the vitality of the child. If the technique is efficient and the air-passages are thoroughly cleared deaths from this cause will be few except in feeble and more particularly premature infants. If the deaths associated with prematurity are to be reduced there must be improvement in the management of labour, a wider application of the newer methods of resuscitation, and further to

play a major part.

research into the causes of premature birth. Too early and too late application of forceps are

a modern there the babies have their own nursery and go to the mothers’ ward only for feeds. In hospital A pneumonia accounted for 21 per cent. of the neonatal deaths after the third day, whereas in B it accounted for only 5 per cent. The figures for B are probably no better than those for any wellrun hospital where the mature babies spend a good deal of their days in the lying-in ward, often in a cot slung on the end of the mothers’ beds. Unless nurseries are exceptionally roomy it is safer to keep the babies apart from one another. There is much justification for complete isolation of premature babies in cubicles, and for mature babies the important thing is to avoid overcrowding and to see that nurses either stay off duty altogether or wear. efficient masks if they show any evidence of an upper respiratory tract infection. The great danger in maternity hospitals is the spread of infection. Among mothers the risk of outbreaks of puerperal sepsis has been almost eliminated, but among babies precautions have not been so effective. Most hospitals still need larger nurseries, with special accommodation for premature babies, including separate cubicles. When such accommodation is provided it will be safe to send very small babies to hospital, accompanied if need be by their mothers. The maternity hospitals will then be making their full contribution to the reduction of infant

being kept in the lying-in ward. B is hospital, well situated and spacious;

mortality. commonly responsible for asphyxia as well as for intracranial haemorrhage, and the injudicious use OXYGEN ADMINISTRATION of anaesthetics and analgesics are obvious A MEMO issued this week by the Ministry of dangers. The methods of resuscitation advocated Health discusses the reasons for giving oxygen and by FLAGG and by BLAIRLEY and GIBBERD4 should compares the efficiency of various types of apparatus, be more widely practised in maternity hospitals, especially the B.L.B. mask described elsewhere in this and the practitioner should hang the half-drowned issue. The most important indication is cyanosis of baby up by the heels and use a mucus catheter. recent origin, and here its efficacy varies with the present. It is most likely to be effective Lessening the number of premature births is more condition where moist sounds in the chest are conditions in to difficult, since many are due pre-eclamptic and in toxaemia and in the

present

state of

our

know-

are unavoidable. After the first week of life the respiratory causes of death are in a different category. They then more closely resemble those of the adult, being due to infection acquired from the child’s environment, and should largely be preventable. Coliform bacilli and staphylococci are often the infecting organisms, in contrast to what is seen in later life, and these organisms may be spread by air-borne droplet infection. During the first month of life the mucous membrane of the alimentary and respiratory tracts is said to acquire a local immunity against organisms of the coliform group through repeated contact with them, but before this is fully established they may set up a pneumonia. These organisms are common inhabitants of the mouth and pharynx of adults. MACGREGOR therefore recommends that newborn babies should be handled as little as possible and should spend little time in the ward with their mothers. She has investigated the neonatal deaths in two maternity hospitals A and B. A is old and overcrowded, the babies

ledge

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bronchopneumonia. widespread plentiful-e.g., It is less likely to succeed, but should be tried, where considerable portions of the lung are airless and moist sounds are few-e.g., lobar pneumonia-and it is not likely to relieve cyanosis of long standing, as in chronic heart failure. In addition, oxygen may be valuable in wounds of the chest with respiratory distress, even without recognisable cyanosis ; and there is evidence to justify the trial of high concentrations (80-90 per cent. in the alveolar air) in the treatment of wound and surgical shock, surgical emphysema, and air embolism. The methods recommended are the nasal catheter, nasal tubes and the B.L.B. apparatus. The familiar glass funnel is condemned as ineffective and wasteful. With a nasal catheter a flow of 4 litres a minute will double the normal concentration of A similar result with oxygen in the alveolar air. comfort can be obtained with nasal tubes greater supported either by the Tudor Edwards spectacleframe carrier (see Lancet,1938, 2, 680) or forkedtube spectacles. With the B.L.B. apparatus the oxygen concentration in the alveolar air can be raised to about six times the normal value (87 per cent.) with a flow of 6 litres a minute. The apparatus is comfortable, tolerated readily for long periods, and economical. 1.

3. Snyder, F. F., Rosenfeld, M. J. Amer. med.Ass. 1937, 108, 1946. 4. Blaikley, J. B. and Gibberd, G. F. Lancet, 1935, 1, 736.

Emergency Medical Services. ministration—Indications,

Apparatus.

H.M. Stationery

Memo No. 5. Oxygen AdMethods and of Types Office. 1940. Pp. 7. 2d.