The premature infant.

Chairman Sanford: Dr. Herman N. Bundesen, Commissioner of Health of Chicago, organized 12 years ago the “Chicago Premature Plan.’ ‘ This consists in registering all premature infants with the City Health Department within a few hours after birth. The premature infant who is born at home, or in a hospital that does not have adequate premature care, is transported in an oxygenated incubator ambulance to a hospital which specializes in such care. From 1936 to 1947 premature infant deaths in Chicago have been lowered 61/2%. The full term infant death rate during the same period has been lowered about 3%. Inasmuch as the premature death rate has been lowered about double that of the full term infant rate, we believe this procedure has been the cause of reduction. In 1936 there were 47,000 live births in Chicago. In 1947 there were 82,000, or an increase of 80%. In this number the full term infants increased from 45% to 60%, whereas the premature infants increased from 2000 to over 5000, or about 140% increase of premature infants born in Chicago during the last 10 years. This adds a considerable increase to the number of infants for our available premature infants beds. Where formerly we planned 5 premature births to each 100 full term births, we now find that prematures have increased to 8 per 100 full term infants. Causes of prematurity are multiple births, toxemia, heart disease, syphilis, tuberculosis, infections, accidents, premature separation of the placenta and abnormalities of the reproduction tract. It is generally understood that there is a tendency for more premature births among the Negro race than the white race. Our Negro population in Chicago has increased in the last 10 years but our increase in premature infants has not been racial. I have no explanation. Premature births certainly are increasing in this area. I have been impressed with another phase and that is many premature infants that we see are from a cesarian birth. Obstetrics has produced more live births but at a premature level. We also find that abnormal pregnancies account for a much higher premature mortality less noticed in the lower weight group. Any good feeding in the hands of a competent pediatrician is entirely satisfactory. In Presbyterian Hospital, Chicago, we use breast milk entirely as a food for our premature infants. This is obtained from our maternity mothers. We encourage breast feeding and most of our mothers have an excess which we pump and bank. The breast milk is frozen in 4 oz. bottles and stored in a deep freeze. This can be used as long as a year later with safety. The City Health Department operates a very efficient breast milk station and will furnish breast milk gratis to any premature infant born in Chicago. If we happen to have an excess, we give it to the City Health Department and they give us credit for it, and then if we run short, we borrow from them. In this way every premature infant is sure of obtaining breast milk. It is not necessary to use pure breast milk for all premature infants. You can use any good type of artificial food and dilute the breast milk with it up to about equal parts, and obtain almost as good results as with pure breast milk, except in very small infants or those who are sick. When we have such a baby, it is taken off our standard formula of equal parts breast milk and lactic acid and given pure breast milk. This formula is a great saving of pure breast milk. How often should a premature infant be fed and how soon should they be fed ? I think the usual tendency is to wait at least 24 to 48 hours, or even longer. They should be fed in the way that is easiest for the baby and easiest for the personnel. We gavage them at 4 hour intervals until the weight is about 4 pounds, then the nurse begins bottle feedings. In some institutions the premature infants