Clinical Review

Recent advances: Paediatrics–I: Infancy and early childhood

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7083.801 (Published 15 March 1997) Cite this as: BMJ 1997;314:801
  1. John Pearn, professora
  1. a Department of Paediatrics and Child Health Royal Children's Hospital Brisbane Queensland 4029 Australia

    Introduction

    Children born in the last decade of the 20th century have been healthier, and will be longer lived, than ever before.1 Recent advances in paediatrics have seen national infant mortality rates fall below 5.0 per 1000 live births. The countries in which this has been achieved–Hong Kong, Taiwan, and Japan–have thus set benchmarks for the century ahead. In the context of world medicine, all who care for children rejoice in the momentum of advanced technology, which is saving hitherto unsavable individual children2 3; yet we are seeing the failings of delivery of health systems whose principles have been proved for decades. The major killers of the 13 million children who die annually before their fifth birthday4 remain pneumonia,5 gastroenteritis,4 malaria,6 measles,7 and trauma.8 The potentiating effects of malnutrition contribute to more than 80% of child deaths from infectious disease.9

    One of the signal advances in paediatrics is the recognition that children's safety8 and health, indeed the very existence of whole races of children10 is a responsibility for all who practise in a contracting world.

    Neonates and infants

    Mortality

    Current best paediatric practice uses neonatal mortality rates specific to birth weight as a combined index of antenatal care and obstetric and paediatric care. In affluent countries these rates continue to fall and show no evidence of plateauing.1 The current United Kingdom neonatal death rate (deaths per 1000 live births in the first 28 days of life) for infants above the median birth weight of 3500 g is 0.9. The international benchmark for all infants who are not premature (those born weighing more than 2500 g) is a rate below 2.0 per 1000 live births.

    The new treatments that have made this possible include the use of exogenous surfactant, high frequency ventilation, extracorporeal …

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