The extra-uterine infections, which usually lead rapidly to death, can take place through the skin, the mucous membranes, the respiratory tract, the eyes, mouth, intestinal tract, and navel. According to Fisch]. and Delestre, with whom I herein agree, the lungs afford, especially in hospital patients, the most frequent point of entry for bacterial inva sion; in this connection, a subnormal body temperature furnishes a pre disposing element. These children usually die within a few days, of a Lemorrhagic form of pneumonia, occurring under the clinical picture of asphyxia, usually running an afebrile course. Delestre found coryza occurring only in premature children with a normal temperature.
Henry describes a rhinitis, running a chronic course in premature children, which, contrary to the associated assumption, is not specific.
diagnosis of prematurity is made, in extreme cases, from the typical general appearance. Besides the small size, the characteristic signs of unripeness strike the eye.
The most important clews, besides the duration of the pregnancy, arc furnished by the weight and measurement of the child.
Fewer external characteristics come into consideration for the diag nosis of debility.
A low body weight—under 2500 Gm. lbs.) (Czerny and Keller) can, as these authors themselves declare, hardly be considered as a sharp boundary. It is rather the general behavior of the child, a dimin ished resistance to external harmful influences (temperature, infection, artificial feeding, etc.), which inform us, often not until weeks after the birth, that we are dealing with a debilitated child.
prognosis of a premature child depends first and foremost on its absolute age, which is its degree of ripeness. A child which is born before the twenty-seventh to twenty-eighth week of preg nancy has only a small chance of remaining alive.
The weight takes second place as an indicator, and therefore a small older child is better off than a large younger one. Notwith standing this, statistics rightly show a decrease in the mortality with increasing natal weight. It is palpably clear that a child weighing 1800 Gm. (4 lbs.), other things being equal, has better chances than an other weighing 1200 Gni. (21 lbs.); then again, the heavier child can have a worse prognosis, provided it be not only premature but also at the same time debilitated.
Hereditary influences: parental diseases, especially maternal (syphi lis, tuberculosis), are very important for determining the capacity for life of the little neonate. When the premature birth is artificially in
duced, because of some mechanical reason (contracted maternal pelvis) the prognosis is naturally better.
According to Budin, children having a rectal temperature of 32° C. (90° F.) and less, die almost uniformly. The behavior of the child immediately after delivery is very important prognostically. Children that cry lustily, move in a lively fashion, drink well, or even suck of their own accord on the proffered breast, have much better prospects than those children, apathetic, hungry, and cold, with temperatures of hardly 32° C. (90° F.) that are not given medical attention until days after birth.
Although the prognosis at first is dubious, it later becomes better in proportion as the care and nutrition are entirely satisfactory, and complications do not occur.
statistics show the influence of the absolute age in the mortality.
Of 56 children of 61 fcetal months....................45 =-- 80.4 per cent. died Of 131 children of 7 fcetal months. ........ ...76 — 58.1 per cent. died Of 53 children of 7,1 fcetal months....................17 = 30.1 per cent. died Of 110 children of 8 fcetal months....................39 =-- 35.5 per cent. died Crede established a mortality of S3 per cent. for children weigh ing 1000-1500 Gm. (2.-3 lbs.); a mortality of 36 per cent. for those weighing 1500-2000 Gm. (3-4 lbs.); and 11 per cent. for those weigh ing 2000-2500 Gm. (41.-51 lbs.).
In these statistics, however, one must remember that the healthy and debilitated premature children are not separated. Francois sepa rated these two classes and arrived at the fact that of 81 premature children of diseased parents (syphilis, tuberculosis, albuminuria) 30 to 37 per cent. died; whereas of 386 approximately healthy premature children, only 4S (12.5 per cent.) died. Just how much can be done, even in institutions, in the way of decreasing the mortality rate of premature children, is shown by the publications of Hutinel and Delestre. who were enabled to reduce the death rate from 66 per cent. to 36 per cent. and later to 14 per cent., "thanks to the almost motherly care, the iso lation of the sick, the use of the conveuse, the mother's milk and a sort of air-eure." According to Groth of Munich, the mortality from congenital debility during the first month of life, is lowest in August and highest in the winter months.