Neonatal screening for sickle cell diseases in Camberwell: results and recommendations of a two year pilot study.

The sickle cell diseases are a major health problem for Afro-Caribbean peoples. Neonatal detection and prophylactic management can reduce mortality and morbidity in childhood. A study was therefore conducted analysing the results of the first two years of cord blood screening in the Camberwell health area. Thirteen cases of sickle cell disease and two of haemoglobin (Hb)C disease were identified among 2202 non-white infants screened. The carrier state, sickle cell trait (HbAS), was present in 11.9% and HbC trait (HbAC) in 4.1% of Afro-Caribbean infants. The incidence of disease and of carrier states was much higher in West Africans than in Caribbeans. The wider implications of screening and the need for a comprehensive plan of care are emphasised.

Occurrence of infection with a parvovirus-like agent in children with sickle cell anaemia during a two-year period.

The occurrence of infection with a parvovirus-like agent during the period April 1979-May 1981 in children attending a single sickle cell clinic in London was investigated. Virus was detected in serum by counter-current immunoelectrophoresis (CIE) and immunoelectron microscopy (IEM). Viral antibody was detected by CIE and specific IgM antibody by an IgM-antibody capture assay. Of the 68 children studied nine presented in aplastic crisis and evidence of infection with the parvovirus-like agent at the time of the crisis was found in all nine. Eighteen of the other children were antibody-positive at some time during the study. In 11 children there was no evidence of recent infection; however, two of these had a history of aplastic crisis in previous years. The other seven seroconverted during the course of the study but did not show any haematological effects. Five of these had a primary infection, one appeared to have reinfection and in the seventh there were insufficient data to distinguish between the two. Possible explanations for the difference between those presenting with aplastic crisis and those with asymptomatic seroconversion are discussed.

Defective yeast opsonisation and functional deficiency of complement in sickle cell disease.

Opsonisation of heat-killed baker's yeast, functional activity of the total alternative pathway of complement, and factor B detected functionally and immunochemically were significantly reduced in 72 children with sickle cell disease compared with 40 age-matched black control children. There was significant correlation between functional activity of the total alternative pathway and functionally measured factor B, but not between factor B measured functionally and immunochemically. The opsonisation defect could be corrected in vitro by normal serum, and factor B-depleted serum, and was qualitatively similar to that seen in patients with primary yeast opsonisation deficiency. Serial studies showed that these serum defects were persistent. Reduction in the activity of components of the alternative pathway of complement and opsonisation was found in 4 patients who had recovered from pneumococcal meningitis and in one who developed osteomyelitis. Defects of yeast opsonisation and complement which are common in patients with sickle cell disease, may partly explain the children's increased susceptibility to infection, and might help to identify individuals especially at risk.

A paediatrician's view of the newborn baby and its epidermis.

Almost all babies born in the United Kingdom are born in hospital and with the continuing improvements in neonatal care more survive than ever before, particularly those of very low birth weight. The use of the manipulative and invasive procedures so necessary to monitor and assist their healthy development often result, however, in skin problems arising from intolerance of adhesives, perforating wounds, cleansing solutions, etc. In the older newborn infant, the main skin problems of the anal and neck regions, in particular, are usually associated with artificial milk feeding and inadequate drying of the skin. Many of the skin rashes seen in the newborn, although worrying, are of no consequence, but all those which are petechial or due to microbial infection require prompt investigation and adequate treatment. Despite the advances of recent years, there is still need for further research into procedures and products to ensure that the infant's protective yet delicate covering is disturbed as little as possible and kept in a healthy condition.

Admissions to hospital of children with sickle-cell anaemia: a study in south London.

Admissions to hospital of 171 children with sickle-cell anaemia, genotype Hb SS, were reviewed over a 20-year period. Altogether 887 admissions occurred in 797 patient-years. The commonest cause of admission was painful vaso-occlusive crisis. Appreciable morbidity also resulted from pulmonary disease, infection, and anaemic episodes. The complications resulting in the most severe illness were acute splenic sequestration, pneumococcal meningitis, and some episodes of erythroid hypoplasia resulting in very low haemoglobin concentrations. Most deaths occurred in children aged under 5. Mortality and morbidity could be reduced by measures including prophylaxis of pneumococcal infections and more active treatment of seemingly minor illness in children with sickle-cell anaemia.

Serum-alpha-hydroxybutyrate dehydrogenase levels in sickle-cell disease and sickle-cell crisis.

In patients with sickle-cell disease (Hb S/S disease) who are not in crisis, the serum-level of alpha-hydroxybutyrate dehydrogenase (alpha-H.B.D.) is significantly above normal. The degree of elevation correlates with the severity of the disease. During infarctive crises the level increases still further by a factor of 2 to 3, and it returns to the patient's normal level on recovery. The level of alpha-H.B.D. thus provides an index of the severity of the disease. Also, it allows distinction between true infarctive crisis, infection, and fake symptoms. In 5 patients a rise in the level of alpha-H.B.D. above the patient's normal level was detected several days before the onset of symptoms, which suggests that there may be a "prodromal" phase.