Case study. Erythropoietin for anaemia in a preterm Jehovah's Witness baby.

An infant born at 24 weeks gestation to Jehovah's Witness parents was made a Ward of Court and treated against their wishes with blood products. Erythropoietin was used without obvious benefit, but the child did well. The parents did not reject the child and maintained a good relationship with medical and nursing staff. We present this case in the light of current discussions on child welfare and recent reform of the law relating to child protection and highlight the many difficult dilemmas faced by the medical team.

Effect of inhaled beclomethasone dipropionate on saliva cortisol concentrations.

Serial saliva cortisol measurements were used to assess pituitary-adrenal function in a group of asthmatic children treated with beclomethasone dipropionate (400 micrograms daily). Asthmatic children who were not being treated with steroids and normal children were also studied for comparison. A diurnal cortisol rhythm was observed in all three groups. Early morning cortisol concentrations were significantly higher in the group treated with beclomethasone dipropionate than in the normal children; this may indicate a stress induced response to decreased morning peak expiratory flow. In both groups, plasma and salivary cortisol responses after adrenocorticotrophic hormone stimulation test were normal but peak cortisol concentrations showed a 7 fold increase over basal values in saliva compared with a three fold increase in plasma. Beclomethasone dipropionate does not suppress pituitary-adrenal function in children when used in recommended doses. Serial measurement of the salivary cortisol concentration is a simple, safe, and sensitive method for the routine monitoring of adrenal function in children treated with this steroid. Monitoring may be supplemented with an assessment of the adrenal response to adrenocorticotrophic hormone stimulation, if necessary.

Glomerular filtration rate in schoolgirls with covert bacteriuria.

Clearance of technetium-99m-labelled diethylenetriaminepenta-acetic acid was used to measure total and individual kidney glomerular filtration rates in 48 girls with covert bacteriuria. The mean (+/- SD) of the total rates of 18 girls with scarred kidneys (99 +/- 24 ml/min/1.73 m2) was significantly (0.005 greater than p greater than 0.002) lower than that in 30 girls with unscarred kidneys (119 +/- 18 ml/min/1.73 m2). This reduction in glomerular filtration was related to the loss of kidney substance associated with scarring rather than to vesicoureteric reflux. The glomerular filtration rate was unrelated to the duration of bacteriuria. These findings suggest that in girls aged 4 and over neither vesicoureteric reflux nor covert bacteriuria contributes to the progression of kidney damage.

Pregnanediols and breast milk jaundice.

Samples of breast milk collected from mothers of infants with breast milk jaundice were analysed for 5 beta-pregnane-3 alpha, 20 beta-diol, and other pregnanediols using gas chromatography-high resolution mass spectrometry. None was detected in any of the specimens and therefore it is unlikely to be the inhibitory factor in bilirubin conjugation. The plasma osmolalities of the infants, which were determined at the onset of jaundice, were within normal limits.

Aetiological factors in rickets of prematurity.

Six very preterm (< 32 weeks' gestation) infants who developed late-onset respiratory distress were each matched for sex and gestation with 2 control preterm infants. Radiologically and biochemically the diagnosis of rickets and rachitic respiratory distress seemed clear and the pattern conformed with other reports of the syndrome. The control infants were of similar gastational ages but there was a significantly higher incidence of pre-eclampsia in the pregnancies of index cases. Also significant was a prolonged illness of several weeks' duration in the index cases; this illness was either heart failure due to patent ductus arteriosus or prolonged ventilation in the early weeks of life for apnoeic attacks. Awareness of these 2 aetiological factors shows the necessity of monitoring such infants for evidence of rickets. The use of water-soluble antirachitic prophylaxis such as 1 alpha-hydroxy-vitamin D or 1,25-dihydroxy-vitamin D is sometimes indicated.

Effects of anti-mite measures on children with mite-sensitive asthma: a controlled trial.

Mite counts and tests for mite antigen were performed on samples of dust taken from the bedding of 53 children with mite-sensitive asthma. The samples from damp houses and the beds or enuretic children had markedly more mites and mite-antigen than those from dry houses. although the predominant species was usually Dermatophagoides pteronyssinus, some of the beds in the damp houses were heavily infested with another pyroglyphid mite Euroglyphus maynei, so that this was the species found in the greatest numbers. D pteronyssinus antigen was found to be correlated broadly with the total mite count, but more antigen was present for a given number of mites in the mattresses than in the blankets. The children were randomly allocated into two groups, one of which carried out rigorous anti-mite measures. The amounts of dust and mite antigen were reduced, though not the numbers of mites. Peak flow readings were monitored in the two groups for eight weeks and a final assessment made by a paediatrician who was unaware of the allocation of each patient in the trial. No significant differences emerged in the progress of the two groups, both tending to improve. Measures designed to remove mites from bedding do not greatly benefit the majority of children with mite-sensitive asthma.

Effect of a change to mite-free bedding on children with mite-sensitive asthma: a controlled trial.

Twenty-one children with mite-sensitive asthma took part in a crossover randomised controlled trial of mite-free bedding. Each child was issued with a new sleeping bag and pillow for a month, and twice-daily peak flow readings were compared with those obtained during a month in the child's ordinary bedding. Seventeen of the children had higher mean peak flow readings during the period in the mite-free bedding (p < 0.01). The overall improvement was only modest, however, and some mites had appeared in most of the bedding by the end of the trial. New bedding may be helpful to patients with mite-sensitive asthma, but methods are needed to prevent colonisation by mites.

Respiratory distress syndrome in infants of Cardiff residents during 1965-75.

The incidence of respiratory distress syndrome (RDS) among singleton infants of Cardiff residents was greater during 1970-4 than in the preceding five years. This was consistent with changes in the distribution of gestational age and birth weight. Case fatality rates among infants with RDS fell only slightly during the period examined. Detailed examination of secular trends during 1965-75 suggested (a) that increased use of elective delivery without assessment of pulmonary maturity increases the risk of RDS, and (b) that innovations in the management of RDS during the early 1970s cannot be assumed to have had widespread impact on case fatality rates.