XN000022-1996-11-20 — Page 51

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(c)

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how the incidence of such cases in the territory compares with those in other countries; and

what measures have been put in place in public hospitals to prevent new- born babies lapsing into a 'vegetative' state?

Reply:

The term "persistent vegetative state" is often used to describe patients with sustained, complete loss of cognition whilst wake/sleep cycles and other automatic functions remain relatively intact. This condition can either follow acute, severe bilateral brain damage or develop at the final stage of progressive dementia.

Severe brain damage among newborn babies occurs most commonly as a result of birth asphyxia. Although statistics are not steadily available, it is extremely rare for "permanent vegetative state" to be caused by birth asphyxia and as far as we can ascertain, no such cases was reported by public hospitals in the past three years.

There is no recognised indicator for the comparison of "permanent vegetative state" as a result of birth asphyxia. The indicator most widely used internationally to compare the health status of newborn babies is the Infant Mortality Rate. At less than 5 per 1,000 live births in recent years, the Infant Mortality Rate in Hong Kong ranks among the best in the world.

All obstetric units in our public hospitals are managed by qualified professional staff, including midwives, to ensure quality patient care. Additional resources will be allocated by the Hospital Authority to individual units through the annual planning process, where necessary, to meet prevailing operational needs. The Authority is also refining its manpower indicators with a view to reflecting more accurately the casemix and patient acuity prevalent in different hospitals.

Unless fully justified on medical grounds, natural delivery is advocated for child birth in public hospitals. When caesarean section for the delivery is needed, advice will be given to the patient whose prior consent must be obtained.

Many conditions such as premature labour, multiple birth, prolapsed umbilical cord, severe maternal bleeding, maternal hypertension and toxaemia may give rise to birth asphyxia. About 70% of these complicated pregnancies can be detected in advance and the risk minimised with good fetal monitoring as well as perinatal care. All public hospitals with obstetric units have established practices and procedures to prevent or reduce the occurrence of birth asphyxia.

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