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This paper describes one year's experience with the running of a special postnatal ward area, established so that babies who needed more treatment and monitoring than is generally undertaken on postnatal wards but who did not need the facilities of the neonatal unit could be kept by their mother's bedside. This 'intermediate care ward' admitted 297 babies with their mothers during its first year of operation. We estimate that the opening of the ward led to a 20% reduction in admissions to the neonatal unit, without disadvantage to any baby. The indications for admission are outlined and the reactions of patients and staff to the innovation discussed. [ABSTRACT FROM AUTHOR]

Immunoglobulin concentrations were determined in 64 consecutively born preterm babies at birth and serially throughout each baby's stay in the neonatal unit. No significant IgG generation was found during the first 15 weeks of life, regression analysis giving an exponential decay model. Concentrations fell to 2 g/l or less in 10 (16%) babies (gestational age 25 to 32 weeks), and were as low as 1 g/l in four babies (gestational age 25 to 29 weeks). The effects of gestational age and birthweight on the concentration of IgG at birth were highly interdependent and significant. Most babies had no detectable IgA at birth, and no effect of gestational age or birthweight, or both, on either initial IgA or IgM concentrations could be shown. [ABSTRACT FROM AUTHOR]

In a prospective survey of infants born in a single maternity unit, asymptomatic faecal colonisation by Clostridium difficile occurred in 31 (47%) of 66 babies who provided a faecal sample during week one of life and at age 14 and 28 days, and in 46 (30.7%) of the total of 150 babies for whom at least one faecal sample was obtained during the month of study. There was no evidence for acquisition of the organism from the mother during delivery and colonisation was unrelated to the means of delivery, infant sex, means of feeding, duration of hospital stay, or antibiotic treatment. New colonisation occurred throughout the month of the study and further evidence for environmental acquisition was obtained by the finding of a similar strain of C difficile in 7 babies from one ward together with positive environmental cultures. Colonisation was frequently transient and occasionally intermittent; most infants kept the same strain during their period of carriage. Twenty two (47.8%) babies colonised by C difficile had low titres of cytopathic faecal toxin but none had symptomatic diarrhoea or features of necrotizing enterocolitis. The in vitro toxigenic potential of 57 toxigenic isolates from 36 babies was low and 12 babies carried non-toxigenic strains. Transient colonisation by C difficile in early life is almost certainly more common than is generally recognized and the neonate provides an important reservoir of potential infection. [ABSTRACT FROM AUTHOR]

Jugular venous occlusion plethysmography was used to measure jugular blood flow in 47 infants; this was done at varying times after the end of a feed. Jugular blood flow was found to be lower, by about 30%, during the first postprandial half hour than at any other time up to 2 hours postprandially. In 2 infants longitudinal studies were performed in relation to several feeds, and postprandial reductions in blood flow of a similar magnitude were found. Aspects of the venous occlusion technique are discussed. It is concluded that feeding in healthy neonates is associated with a subsequent reduction in jugular blood flow, and possible mechanisms for this phenomenon are discussed. [ABSTRACT FROM AUTHOR]

One hundred mothers and 50 medical students and doctors were interviewed to examine their understanding of eight common probability expressions as they are used in statements of the kind that doctors regularly make to mothers of babies. Respondents were asked to translate each term into a number on a scale from 0 to 10. There was a wide range of interpretation of the expressions, and significant differences were found between the mothers and medical group for seven of the expressions. Most mothers expressed a preference for receiving information in numerical terms. We advise that verbal probability expressions should be restricted, and more information presented in numerical terms. [ABSTRACT FROM AUTHOR]

The tetracosactrin stimulation test was used to assess the adrenal responsiveness of 22 very low birthweight babies who had received a three week course of dexamethasone for the treatment of bronchopulmonary dysplasia. Five babies were studied in detail with blood samples taken for cortisol concentrations at 30 minute intervals for four hours. The tests were performed before, during, and after treatment with dexamethasone. A distinctive pattern of cortisol response to tetracosactrin was found among these babies, which was quite unlike that found in older children and adults. Using our pretreatment results as control data we conclude that there is undoubtedly evidence of modest suppression of the adrenal axis during dexamethasone treatment, although there is considerable recovery one month after stopping steroids. Basal cortisol concentrations, however, remained low in some cases, which may indicate the need for temporary corticosteroid replacement during severe illness. [ABSTRACT FROM AUTHOR]

Eighty four very low birthweight babies (considered high risk for developing necrotising enterocolitis) were given vancomycin orally for 48 hours before introduction of oral feeds; one developed necrotising enterocolitis. One hundred and twenty very low birthweight babies (not considered such high risk) were fed without first receiving vancomycin; 17 developed necrotising enterocolitis. Although this was not a randomised control trial, results indicate a role for vancomycin in prophylaxis of necrotising enterocolitis. [ABSTRACT FROM AUTHOR]

In two newborn infants who had experienced severe asphyxial insults, and who showed noticeable signs of brainstem dysfunction, all components of the auditory brainstem response except the eighth nerve potential became undetectable. Both babies survived, their brainstem responses returned, and one of them is judged to be developmentally normal at the age of 18 months. Clinical signs of brainstem dysfunction with complete cessation of conduction in the brainstem auditory pathway cannot be taken, therefore, as a sign of irreversible brainstem damage in the human newborn. [ABSTRACT FROM AUTHOR]

We report a case of neonatal infection with rhizopus, one of the Mucoraceae family. Human infection is rare but the mortality is high without prompt, correct treatment. The infant had a simultaneous candida septicaemia secondary to colonisation of a central venous line. Serial C reactive protein estimations are valuable in monitoring treatment. [ABSTRACT FROM AUTHOR]