Browsing by Author "Jayawardene, D.R.K.C."

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    Morbidity and mortality of neonates associated with meconium stained liquor in labour
    (Sri Lanka Medical Association, 2000) Jayawardene, D.R.K.C.; Sirisena, J.
    INTRODUCTION: Few prospective studies have been performed in Sri Lanka to determine the morbidity and mortality of neonates associated with meconium stained liquor at delivery (MSLD) and rneconium aspiration syndrome (MAS) OBJECTIVES: 1. Determine the incidence, morbidity and mortality of MSLD. 2. Determine the differences in the outcome of babies who had meconiurn above and below the vocal cords. 3. Determine whether foetal heart sound (FHS) and CTG (cardio-tocography) are predictive of MSLD and MAS. METHOD: A prospective study of 77 babies with MSLD at the Professorial Units, Teaching Hospital, Ragama, during a four month period was done. 68 were examined by the PHO with a laryngoscope to detect meconium above or below the vocal cords. All babies were kept under observation for signs of MAS. Respiratory rate, oxygen saturation, CXR changes were recorded, RESULTS: Of 1447 live births 77 (5.3%.) had MSLD, 35 were admitted to a SCBU and 11 (31,41%.) developed MAS. There were 2 deaths (16.7%). 4/58 (6.891%.) with meconium above the vocal cords had MAS compared to 7/10 (70%.) babies who had meconium below the vocal cords (P<0. 001). CTG abnormalities were seen in 13/50 (20%) babies with MSLD, and 3/11 (27,7%) babies with MAS. .FHS abnormalities were seen only in 9/77 (11.87%) babies with MSLD; out of this 2 (22.2%) had MAS. 68/77 (88%) MSLD had regular FHS and 9/1 1 (8 1 %) babies with MAS had regular FHS. CONCLUSIONS: The incidence of MAS following MSLD is low. Meconium below the vocal cords was associated with poor prognosis. FHS and CTG abnormalities were not predictive of MSLD or MAS.
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    Pattern of neonatal mortality in a Special Care Baby Unit
    (Sri Lanka Medical Association, 1999) Karunasekera, K.A.W.; Jayawardene, D.R.K.C.
    INTRODUCTION: In Sri Lanka, neonatal deaths account for 80% of infant mortality. Awareness of neonatal mortality pattern plays an important role when implementing measures to reduce the incidence of neonatal deaths. OBJECTIVES: To estimate neonatal deaths in relation to gestational age, and to identify the major causes of neonatal mortality. METHODS: Babies admitted to the University Special Care Baby Unit (SCBU), Ragama, from January 1996 to December 1997 were studied. Gestational age, birth weight, diagnosis and outcome were recorded for all babies. Total number of births including stillbirths and live-births, gesta¬tional age and birth weight of all the babies born in the University Obstetrics Unit were recorded at monthly perinatal mortality meetings. RESULTS: Total number of live-births in the University Obstetrics Unit was 3849 and 4316 in 1996 and 1997 respectively. Out of these 10.9% and 12.1% were admitted to the SCBU in 1996 and 1997 respectively. Prematurity rates were 9.3% and 7.2% in 1996 and 1997 respectively and low birth weight (LEW) rates were 1 7.4% and 17-7% in 1996 and 1997 respectively. Neonatal mortality rates per 1000 live-births in 1996 and 1997 were 10.7 and 11.1 respectively. Perinatal mortality in 1996-and 1997 were respectively, 22 and 24 per 1000 total births. Mortality rates for babies with gestational ages under 28 weeks, 28-32 weeks, 33-34 weeks, 35 - 36 weeks, 37 - 40 weeks and more than 40 weeks were 100%, 53.31 %, 20%, 1.8%,' 0.4%, and 0.8% respectively. Common causes of deaths in 1996 were septicaemia (23.4%), birth asphyxia (21.3%), prematurity (21.3%), meconium aspiration (10.6%), and hyaline membrane disease [HMD; (10.6%)]. Prematurity (28.8%), birth asphyxia (19.2%), meconium aspiration (17.3%) and HMD (13.5%) were the common causes in 1997. CONCLUSIONS: Prematurity greatly contributed to the high perinatal mortality; mainly gestational ages 32 weeks and below. Other common causes of neonatal deaths were septicaemia, asphyxia, meconium aspiration and HMD. Thus, facilities for perinatal monitoring, resuscitation, managing very sick babies including ventilation and surfactant therapy should be available, at least at regional levels, in Sri Lanka in'order to reduce perinatal mortality rates.