Antenatal Protection of Infancy

ANTENATAL PROTECTION OF INFANCY (from Latin ante- before and natare- to give birth), protection of the child before birth, has as its aim the reduction of infant mortality and stillbirths. The question was first raised in 1895 by Pinard in a report titled "Puericulture intrauterine" before the French Academy. The necessity of antenatal protection of infancy is demonstrated by data on mortality of children in the first month of life ("early mortality, mortality of newborns"), according to which mortality of children in the first year of life is largely determined by mortality in the first month (Rott). In Germany in 1920, according to data from the Department of Statistics, mortality in the first four weeks constituted 1/3 - 1/7 of all deaths in the first year of life. Of 199,200 children dying annually in the United States, which constitutes 7.6% of the number of live births, 109,000 children die in the first month (Dublin). In Leningrad, according to data by Binshtok, mortality in the first month amounted to 6.3% per 100 live births for 1906-1915. In recent decades, infant mortality has decreased significantly everywhere (see Infant Mortality). In this steady decline in infant mortality in the 1st year of life, the age up to one month hardly participates at all (according to data from a number of authors, mortality in the 1st month not only does not decrease, but even increases). Thus, in 1920 in Australia, early mortality amounted to 31.8 per 1,000 live births, whereas in 1910 it was 30.2 (Dublin). Similar figures are obtained on the basis of data on child mortality in Leningrad: while mortality from the 1st to the 12th month fell from the period 1909-14 to 1923 by 51%, mortality in the age group under 1 month during the same period fell only by 19.3%. On the basis of a thorough study of Dublin's data, the following important conclusions are reached: 1) mortality of newborns is a variable quantity; it varies within rather wide limits; 2) there is a fairly complete correlation (relationship) between mortality of early age (up to one month) and mortality from the 1st to the 12th month, i.e., lower mortality up to one month is encountered simultaneously with lower mortality after the first month; 3) measures for antenatal protection of infancy influence the reduction of early mortality and stillbirths; 4) the rate of decline in mortality in the first month, even under favorable conditions, is still somewhat slower than in the age after the first month. If to the figure of early mortality is added the number of stillbirths (such summation is dictated by the circumstance that the causes of early mortality and stillbirths are almost the same), then the figure becomes even more impressive: the number of stillbirths constitutes from 3% to 5% of the number of live births (Heinecke). l \ ч/ \ \ s л \ V/ > )O0O a_p Oot ^эooo _Oo°< ЭООо '%, -'' ¥ к эоо< Pooo >oa» s ^/""- *- °ООЦ ~ч ,- J^v ^U° 1009 10 И 12 li 14 15 16 17 19 20 21 22 23 24 Of 1,000 live births died from °"°° congenital weakness, ------ pneumonia, - nutritional disorders (according to Zeltner). If we turn to the causes of mortality, then of the three main groups-gastrointestinal diseases, diseases of the respiratory tract (pneumonia) and congenital weakness-the first experienced a significant decrease, the second remained almost unchanged, and the third underwent a change in the direction of increase. This is demonstratively shown by Zeltner's curve. Congenital weakness claims the most victims in the first month; from it 60 out of 100 of all who died in the 1st month die. After 2 months, congenital weakness, as a cause of death, constitutes only 3%. The vast majority of deaths in the first day of life are caused by congenital weakness: according to Rott-90 out of 100. In relation to total mortality up to one year, congenital weakness is, according to Rott, the cause of mortality in 1/5 of all cases. According to data from the Leningrad Statistical Department, congenital weakness in 1923 constituted 34.8%, according to Baker-40% among causes of death in the first year. Under the diagnosis "congenital weakness" various conditions are registered. Thus, according to Rott, in Prussian statistics congenital weakness and developmental defects are combined into one group. Into this same category actually fall not only weak-born infants but also premature infants, as well as those who died during and shortly after birth due to complications during delivery. Such inaccuracies in registration undoubtedly occur everywhere. Of all groups registered as weak-born, the largest is the group of premature infants. Prematurity constitutes 3-5% of the number of live births. Premature infants are the most frequent victims of death in the 1st month of life; in 1922-1923 in Berlin, out of 100 deaths from so-called congenital weakness, 71.4 cases were of prematurity; 9.3% fell on injuries during childbirth and only 19.3%-on congenital weakness (functional inability for extrauterine life, according to Pfaundler). Prematurity and weakness at birth are divided into three groups: 1) prematurity as a result of traumatic injuries and surgical intervention, 2) prematurity as a result of excessive labor and weakness of the mother, 3) prematurity and weakness as a result of maternal illness. The prognosis from these causes is very different. The decisive moment is the state of health of the parents, mainly the mother: of prematurely born infants from healthy mothers, 21.5% died in the 1st year, from sick mothers-89.4% (Lorey). Of 100 premature infants born from healthy mothers, survive, according to Pfaundler, in the first days of life 75, in the first year-63. Of 100 infants from sick mothers survive in the first days 62, in the first year-18. Maternal diseases cause weakness at birth and prematurity: a) chronic infections; of these, syphilis takes first place, second-tuberculosis; b) chronic intoxications (mainly alcoholism, then-poisoning by industrial poisons-lead, mercury, phosphorus, arsenic, nicotine, etc.); c) among chronic diseases (non-infectious), the most unfavorable influence are heart diseases, then-metabolic diseases (diabetes, Basedow's disease); d) acute maternal infections during pregnancy (malaria, etc.); e) particularly great importance are diseases associated with pregnancy itself, as nephropathia, eclampsia and local diseases of the sexual sphere: endometritis, incorrect positions, etc. The most frequent cause of prematurity in healthy mothers is excessive physical strain as a result of professional labor. In further development, authors find in surviving weak-born and prematurely born infants hypoplastic and asthenic phenomena, hydrocephalus, neuropathy, etc. Ylppo found among them 7.4% idiocy and imbecility, 3.1%-symptom-complex of Little, etc. All authors agree that in the struggle against mortality and morbidity in the first days of life, first place belongs to the protection of the future mother. The results of antenatal protection of infancy are reflected in the figures of neonatal mortality as well as stillbirths. According to Dublin's data, stillbirths in 1920 in New York amounted to 46.5 per 1,000 births; among women who used antenatal protection (consultation), the number of stillbirths amounted to 25 per 1,000. Mortality of newborn infants amounted to 35 per 1,000; among those under protection-25.9 per 1,000. Thanks to measures of antenatal protection, mortality in the first month in Amsterdam fell from 23.2 per 1,000 live births in 1905 to 13 in 1922. Of 100 syphilitic mothers, untreated, 74% aborted or gave birth to dead children (data from Tixier - Paris 1924, congress of pediatricians). Of 100 pregnant women treated with salvarsan-mercury or salvarsan+bismuth, 6% gave abortion and stillbirth, the rest gave birth to healthy children (data from Iersild and Krlstjarisen, Copenhagen, 1925, report at the conference on congenital syphilis in Paris). Thanks to measures of antenatal protection in France, eclampsia and dystocia-as causes of early mortality and stillbirths-disappear. Weight of newborns, as one of the indicators of child development, with rest for the mother in the last period of pregnancy (Pinard, Peller, Michnik) increases by 250-300 g. Particularly great importance from the socio-hygienic and eugenic point of view is antenatal protection of infancy in the prevention of congenital syphilis. Treatment of women during pregnancy is one of the most rational measures for the prevention of congenital syphilis. Congenital syphilis occurs, according to German and Russian data, in 2-4 cases per 100 births; according to French-in 30 cases; 52% of pregnancies in syphilitic women end in miscarriage or death of the newborn at birth or shortly after it (Davidsohn); children with congenital syphilis die, according to Davidson, in 69% of cases; premature syphilitic infants, according to Planchu-in 75% of cases. Great social significance has antenatal protection of infancy in the direction of prevention of homelessness, abandonment of children, infanticide.

Antenatal protection of infancy will play an extremely important role in the future in the eugenic direction, i.e., in preventing the birth of obviously inferior, hereditarily diseased offspring from alcoholics, mentally ill, nervous patients, etc. (Grotjahn, Lentz). Measures for antenatal protection of infancy can be divided into the following groups: I. Legislative measures: protection of labor for women in general, and pregnant women in particular, especially in industries harmful to motherhood; maternity insurance; leave during pregnancy. In this respect, Soviet legislation occupies first place among the world's legislations. It is also advisable to introduce mandatory medical examination of those entering marriage to prevent the birth of obviously diseased offspring. Laws on compulsory treatment of syphilitics, on criminal liability for infecting with syphilis, laws on the registration of patients with venereal diseases, etc., also serve the purposes of antenatal protection of infancy. II. Sociohygienic measures: 1) Medical-social institutions for the protection of pregnant women. The central place is occupied by the 'Women's Consultation' (see Consultation). 2) So-called consultations on 'birth control,' 'hygiene of marriage' (Antonov, Lyubinsky, Michnik, Feldmann, Delfino) should acquire important significance. Their tasks are: a) to contribute to the improvement of offspring through negative and positive eugenics; b) to regulate childbirth for the protection of the health of the mother and family; c) the fight against artificial and natural abortions through education in the practice of contraceptives. These institutions exist in America and Western Europe; in the USSR they are beginning to penetrate life as a measure to combat abortions, in the form of departments at women's consultations. 3) Socio-legal protection (to prevent vagrancy, abandonment, etc.) is carried out through the mediation of social assistance councils and legal consultations. 4) One branch of social assistance consists of closed institutions for healthy pregnant women: homes for mothers and children, shelters, refuges for single and indigent pregnant women, departments for pathological pregnancies. 5) An extremely important branch of antenatal and intranatal assistance is the organization of obstetric care. Hospitalization has an advantage over out-of-hospital care. This question is particularly important for the countryside, where the midwife plays a significant role in the matter of antenatal protection of infancy. The duty of the midwife, from the point of view of antenatal protection of infancy, is sanitary-educational work on the hygiene of pregnancy, childbirth, and the newborn, preparation for childbirth. Scientific institutions are of particular importance in the matter of antenatal protection of infancy: institutes for the protection of motherhood and infancy, for combating occupational diseases, etc. The task of the institutes is the scientific development of issues related to motherhood, especially data on early mortality, the study of measures for antenatal protection of infancy, the methodological development of issues of antenatal protection of infancy, the training and retraining of personnel. The systematic implementation of measures for antenatal protection of infancy contributes not only to the reduction of infant mortality and stillbirths, but also to the reduction in the number of miscarriages.