Plasma 1.25-dihydroxyvitamin D concentrations in preterm infants.

1.25-Dihydroxyvitamin D concentrations were measured in 10 preterm infants (mean gestational age 29 weeks, range 26-32; mean birthweight 1226 g, range 980-1700). Total parenteral nutrition was begun after birth and partial enteral feeding was started at 1 week of age. Total enteral feeding was achieved at a mean age of 26 days (range 16-47). The daily vitamin D3 intake was about 400 I. U. No clinical, chemical or radiological signs of rickets were observed. The mean 1.25-dihydroxyvitamin D concentration +/- SEM was 103.2 +/- 24.0 pmol/l at 1 week (range 9.6-252.0), 141.6 +/- 26.4 at 3 weeks (range 31.2-324.0), 153.6 +/- 21.6 at 6 weeks (range 67.2- 256.8), 165.6 +/- 24.0 at 9 weeks (range 74.4-307.2) and 153.6 +/- 21.6 at 12 weeks (range 76.8-268.8) postnatal age. The mean values at 6, 9 and 12 weeks were significantly higher (p resp. less than 0.01, less than 0.002 and less than 0.005) than in adults (88.8 +/- 7.2; n = 27). 1.25-Dihydroxyvitamin D concentrations were highly variable and did not correlate with 25-hydroxyvitamin D concentrations, plasma calcium and phosphorus concentrations and plasma alkaline phosphatase levels, nor with illness nor postnatal age. The data demonstrate that preterm infants are capable of producing high plasma levels of 1.25-dihydroxyvitamin D.

Primary restrictive foramen ovale.

A newborn infant with primary restrictive foramen ovale, tubular hypoplasia of the aortic arch, and some other developmental defects is described. This combination resulted in fetal hydrops, as was shown by ultrasonography. The child died 24 h after birth due to low output syndrome and extensive bronchopneumonia. The pathogenesis of this clinical entity is discussed.

Passive-active immunisation of neonates of HBsAg positive carrier mothers: preliminary observations.

Screening of pregnant women for hepatitis B surface antigen (HBsAg) in three areas of Holland led to the identification of HBsAg carriers, 20 of whom were subsequently delivered. Within two hours after birth all infants received hepatitis B immune globulin (0.5 ml/kg body weight) and, after randomisation, hepatitis B vaccine (10 micrograms) was given either at 0, 1, and 2 months of age or at 3, 4, and 5 months of age, the latter concomitantly with DPTP vaccination. Eighteen infants complying with the protocol were followed up for at least six months. No side effects were observed after either passive or active immunisation. All infants developed high concentrations of anti-HBs antibodies; no interference of high dose passive immunisation with active immunisation was observed. Concentrations of anti-HBs at three months were significantly lower in infants given delayed active immunisation than in those given early active immunisation. These data suggest that passive-active immunisation against hepatitis B virus infection is well tolerated by neonates under 3 months of age and that both early and late active immunisation in combination with passive immunisation will result in excellent anti-HBs production.

Toxic epidermal necrolysis probably due to Klebsiella pneumoniae sepsis.

We describe a case of toxic epidermal necrolysis probably caused by Klebsiella pneumoniae septicaemia. The clinical and histological findings of this patient were typical for toxic epidermal necrolysis.

Preferential looking acuity in preterm infants.

Acuity was measured in 48 prematurely born infants using the preferential looking technique. These quantitative results show that acuity development in these infants is related to conceptional rather than postnatal age, in agreement with the qualitative findings of previous studies. Severe intraventricular haemorrhage was accompanied by low visual acuity in two infants.

Quantitative study of the aerobic and anaerobic faecal flora in neonatal necrotising enterocolitis.

Faeces from 24 neonates with proved necrotising enterocolitis (NEC), from 12 with clinically suspected NEC, and from 41 control infants were quantitatively cultured under aerobic and anaerobic conditions. An important difference in colonisation with Klebsiella was found between the NEC groups and the control group. Although the cause of NEC is unknown, colonisation with Klebsiella seems to increase the risk.

Familial congenital heart block and hydrops fetalis.

Two siblings were born with congenital heart block, and one suffered from severe hydrops fetalis, although maintaining a higher heart rate than the other. The association of hydrops fetalis with disorders of cardiac rhythm is unlikely to be simply a manifestation of congestive cardiac failure in the fetus.