Birthweight-specific risk factors for necrotising enterocolitis.

In a multicentre case-control study of necrotising enterocolitis risk factors were found to vary with birthweight of cases. In very low birthweight cases the risk factors identified were those associated with prolonged or recurrent hypoxia (recurrent apnoea, respiratory distress, assisted ventilation, and umbilical artery catheterisation). In heavier birthweight infants the risk factors were, in contrast, related to hypoxia at birth (low 1 minute Apgar score and endotracheal intubation at birth) and umbilical vessel catheterisation used in exchange transfusions. Contradictory findings in published case-control studies carried out in the USA may be due to differences in patient populations and management policies. Hypoxia and umbilical vessel catheterisation should still be considered as risk factors for necrotising enterocolitis.

The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions.

Twenty-five severely rhesus-isoimmunized fetuses, including 15 with hydrops fetalis, underwent a total of 77 intrauterine transfusions between 19 and 32 weeks' gestation. Fifty-eight of the procedures were fetoscopically directed intravascular transfusions, nine were ultrasound-guided intraperitoneal transfusions, and 10 were a combination of intravascular transfusion, fetal paracentesis, and intraperitoneal transfusion. The average number of antenatal procedures per patient was three (range, one to five). The survival rate for the 19 fetuses that received their initial intrauterine transfusion at or before 25 weeks' gestation was 84%; 11 of the 13 hydropic fetuses and five of the six fetuses without antenatal evidence of hydrops survived. In six cases hydrops fetalis was reversed in utero. The outcome in patients referred after 25 weeks' gestation was poor; neither of the two hydropic fetuses and only two of the four nonhydropic ones survived, which suggests the importance of early referral to a team experienced in the management of this problem. However, most of these fetal losses occurred early in the series. Seven of the 20 neonates were hydropic, and nine had severe thrombocytopenia (platelet count, less than 50,000 X 10(6)/L). The mean cord blood hematocrit and bilirubin of the neonates were 25.1% and 82 mumol/L, respectively. The babies required a total of 69 exchange transfusions (range, 0 to 9) and 68 simple transfusions (range, 0 to 25). One newborn infant who had had ultrasound evidence of hydrops fetalis at 22 weeks' gestation did not require any exchange transfusions. Nine patients required intermittent positive pressure ventilation (eight had respiratory distress syndrome and one had apnea) for a range of 1 to 86 days. The neonatal survival rate was 90% (18/20).

Double-blind comparisons of slow-release theophylline, ketotifen and placebo for prophylaxis of asthma in young children.

Clinical trials of slow-release theophylline and ketotifen as prophylaxis against asthma in 18 young children suggested that both drugs had some efficacy. The theophylline was more effective and produced reduction in salbutamol usage as well as an increase in peak expiratory flow rates. Transient nausea and vomiting was commoner during theophylline treatment but did not usually necessitate discontinuing therapy.

Neonatal paracetamol poisoning: treatment by exchange transfusion.

The metabolism and excretion of paracetamol was studied in an infant of 29 weeks' gestation who was exposed to the drug when his mother ingested 32.5 g 16 hours before delivery. We have confirmed that sulphation is the major pathway and that the mixed function oxidase system is sufficiently active at this gestational age to produce hepatotoxic metabolic products. As most of the recognised drug treatments for paracetamol poisoning seemed unsuitable in this case, the infant was treated with exchange transfusions.

A controlled comparison of slow-release theophylline, ketotifen and placebo in the prophylaxis of asthma in young children.

A double blind crossover comparison of slow-release theophylline, ketotifen and placebo was carried out in 18 young children with perennial asthma. Theophylline significantly reduced symptoms and increased the mean peak expiratory flow rate. Transient nausea and vomiting was commoner during theophylline treatment but did not usually necessitate discontinuance of therapy.

Neurological normality after extreme birth asphyxia. Case report.

A case of extremely severe birth asphyxia is reported. In spite of successful resuscitation the arterial pH was still only 6.6 at the age of 1 h. Assessment at 3 years 10 months revealed that the child was not only completely normal, but was of superior intelligence. This case demonstrates the advisability of maintaining an optimistic approach even when very severe fetal acidosis is detected around the time of birth.

The weights of aboriginal infants: a comparison over 20 years.

At Cherbourg Aboriginal Settlement the weight gains of infants remained at a constant level below the Australian average from 1953 to 1972. During this period the infant death rate decreased from about 28 per 1,000 live births to about 40 per 1,000 live births. At Palm Island Settlement the death rates have remained high and the growth rates low. The pattern at Cherbourg suggests that the people at Cherbourg have learnt how to use appropriately the hospital and health services, but have not yet made any major changes in the standards of infant care.