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A response by S.H. Flack, N.A. Piper and A.M. Lynn to a letter to the editor about their paper "Epidural analgesia in a patient with an intrathecal catheter and subcutaneous pump to deliver baclofen" in the 2006 issue of "Pediatric Anesthesia" is presented.

There are a limited number of hydrolysed feeds on the market designed to meet the specific nutritional requirements of children ( ). Adult feeds are unsuitable for children as the protein content is too high and exceeds requirements ( ). The energy density of hydrolysed infant formulas is inadequate for this age group: 66 kcal/100 ml vs 100 kcal/100 ml in the trial feed. Currently the only paediatric hydrolysed feed available in the UK is pork-based and is contraindicated for some ethnic groups. This study has evaluated the use of a new feed for children based on whey hydrolysate. Fifteen subjects, mean age 4.3 years (range 2.7–10.5 years), were recruited. All required a supplementary feed because they were unable to maintain good nutritional status from food alone. Ten subjects were already established on a hydrolysed or elemental feed and five had previously taken a normal diet. Eight had a diagnosis of eosinophilic enteropathy whereas others had food intolerance of unknown aetiology. Subjects were established on the new feed over 4 days and were reviewed after a 28-day period. Weight and symptom data were recorded at the beginning and end of the trial period. One-third of the patients were followed up for 2–5 months after completion of the trial. The mean standard deviation score (SDS) for initial weight was −1.5 (range −3.92 to +0.29). After 28 days, SDS mean was −1.5 (range −4.0 to +0.17). The mean change in weight was +0.01 SDS (range −0.61 to +0.73). For children already established on hydrolysed/elemental feeds, mean SDS weight change was +0.01, whereas for patients new to an exclusion diet supplemented with trial feed the change was zero. Of eight children seven (88%) with diarrhoea improved, of three children three (100%) with vomiting improved and five of six children (83%) with abdominal pain improved during the 28-day trial period. Nine of 15 subjects (or parents) considered that their symptoms improved and they chose to continue with the trial feed. Five of these had been receiving a hydrolysed/elemental feed and four had previously taken a normal diet. At follow-up 2–5 months later, four of nine children remaining on the trial feed showed positive changes in weight SDS since starting the feed, one child showed a negative change and no weight data were available for the remaining four subjects. This new paediatric feed based on whey hydrolysate is suitable for most ethnic groups, is well accepted and tolerated and provides a more suitable nutrient profile than existing products designed for adults or infants. Objective reporting using standard symptom charts showed that symptoms had markedly improved during the trial period. The results suggest that a trial period of 1 month may not be long enough to establish the efficacy of a new feed using catch-up growth or improvement in weight SDS as the main outcome measure. This work was supported by Nestlé Clinical Nutrition [ABSTRACT FROM AUTHOR]

Background and Objectives The administration of therapeutic plasma protein concentrates has been associated with the real risk of transmitting viral diseases and the theoretical risks of prion transmission. Our objective was to determine if γ-irradiation can inactivate viral or prion infectivity without damaging a protein biotherapeutically. Materials and Methods Human albumin 25% solution, spiked with four model viruses (including porcine parvovirus) or with brain homogenate from scrapie-infected hamsters, was γ-irradiated at constant low-dose rates and assayed for viral and prion infectivity or for albumin integrity. Results At a radiation dose of 50 kGy, viruses were inactivated by ≥ 3·2 to ≥ 6·4 log10 and scrapie by an estimated 1·5 log10 , whereas albumin was only moderately aggregated and fragmented. Conclusions γ-Irradiation can preferentially inactivate viral and prion pathogens without excessive damage to albumin structure. [ABSTRACT FROM AUTHOR]