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A prospective study was carried out to identify the immediate and long-range advantages and disadvantages of a walking-donor transfusion program for an intensive care newborn nursery. The effect of heparin on coagulation of blood was evaluated and found to be minimal. There was no evidence of transmission of HB 8 Ag. The prevalence of CMV infection at the time of follow-up was higher in infants who had received blood from donors seropositive for CMV than in infnats who had been transfused from seronegative donors. In our experience, a walking-donor program has been a safe and effective method for the provision of small transfusions of blood to sick neonates.

Fifty-five infants who survived respiratory failure in the neonatal period with the aid of assisted ventilation were studied in order to evaluate their long-term prognosis. Over 80 per cent of these infants had normal intelligence and either minimal or no neurologic abnormalities. Only four infants had I.Q. scores of less than 85. The incidence of neurologic and intellectual handicaps was highest in low-birth-weight infants (

Forty-six neonates with hypoxemia were treated with tolazoline, a pulmonary vasodilator, within the first two days of life. Eight of ten (80%) infants without apparent lung disease responded with a mean increase in PaO2 of 116 torr within one hour of beginning tolazoline infusions. One of the responding infants and two nonresponders died. Thirty-six additional infants with a variety of pulmonary disorders had severe hypoxemia which was refractory to mechanical ventilation. Twenty-one (58%) responded with a mean increase in PaO2 of 130 torr within one hour after beginning tolazoline and 13 (62%) of these survived. Fifteen patients had little or no improvement in PaO2 following tolazoline and only three (20%) of these infants survived. Responders could not be distinguished from nonresponders by clinical or laboratory features prior to therapy with tolazoline. Fourteen infants experienced complications possibly related to tolazoline.

Nine children were evaluated two to three years after institution of either medical or surgical management of their hiatal herniae. Four children treated medically ranged from 6 to 16 months of age. Three were clinicalluy cured of symptoms and one clinically improved, indicating the efficacy of medical management in some young children. The firth medically treated child, age 10 years, was also clinically improved. Four children initially had surgical hiatal hernia repair: one (16 days old) because of pulmonary aspiration with associated cardiorespiratory arrest, two (age 3 and 6 years) because medical management failed, and one (age 7 years) who presented with an esophageal stricture. Surgery for hiatal herniae in children should be researved for patients in whom medical management has failed or for patients with serious complications.

Elevated concentrations of blood NH 3 were found in seven infants who were receivingcasein or fibrin hydrolysates intravenously. Hepatic enzymes and/or hepatic histology were abnormal in four of these seven infants. The high concentration of NH 3 in the protein hydrolysate preparation may contribute to the hyperammonemia.

The effects of pasteurization, lyophilization, and freezing on immunoglobulin and lymphocytes in human milk was studied. We found a significant decrease in total lymphocyte count after all three processing methods. Pasteurization and lyophilization caused a significant decrease in immunoglobulin concentration and in specific antibody titer to Escherichi coli . Freezing specimens up to four weeks resulted in no significant alteration of IgA content or in E. coli antibody titer. Since a major advantage of human milk is the transference of passive local immunity, these quantitative changes may have clinical importance.

Thirty-nine critically ill infants with pulmonary disease received tolazoline because of severe hypoxemia refractory to administration of 100% O2 and mechanical ventilation. Twenty-seven (69%) of the infants responded with an increase in PaO2 greater than or equal to 20 torr in the first umbilical arterial gas after completion of the initial ten-minute infusion (1 to 2 mg/kg) of the drug. A response was not correlated with survival. The overall survival was 46%, essentially unchanged from our previous report (44%). Infants with hyaline membrane disease had the poorest survival rate (33%). Complications associated with the use of tolazoline occurred in 82% of the infants. A hypotensive reaction, defined as a 25% decrease in mean arterial pressure from the pre-tolazoline level, occurred in 67% of the infants, and more commonly in the infants with RDS (87%). In 11 infants who did not respond to the initial dose of tolazoline, the dose was increased up to 10 mg/kg/hour; only one infant responded, and eight (73%) had a hypotensive reaction.

6. Enhorning G, Grossman G, Robertson B: Tracheal deposition of surfactant before the first breath, Am Rev Respir Dis 107:921, 1973. 7. Fujiwara T, Chida S, Watabe Y, Maeta H, Morita T, and Abe T: Artificial surfactant therapy in hyaline membrane disease, Lancet 1:55, 1980. 8. King R J, and Clements JA: Surface active materials from dog lung. !L Composition and physiologic correlations, Am J Physiot 223:715, t 972. 9. Hallm'an M, Schneider HA, and Gluck L: Human fetus, a potential surfactant donor: isolation of lung surfactant from amniotic fluid, Pediatr Res 15:663, 1981. 10. Pearson D J, Mentnech MS, Gamble M, Taylor G, and Green FHY: Acute pulmonary injury induced by immune complexes, Exp Lung Res 1:323, 1'980. 11. King RJ and Macbeth MC: Physicochemical properties of dipalmitoyl phosphatidylcholine after interaction with an apolipoprotein of pulmonary surfactant, Biochim Biophys Acta 557:86, 1979.

Sodium nitroprusside was administered to 58 neonates, including 11 with severe respiratory distress syndrome, 15 with persistent pulmonary hypertension of the newborn, 28 with clinical shock, three with systemic hypertension, and two with pulmonary hypoplasia, all refractory to conventional intensive therapy. Nitroprusside was infused at 0.2 to 6.0 μg/kg/min for periods of 10 minutes to 126 hours. Infants with severe respiratory distress syndrome had increased Pa o 2 and decreased Pa co 2 or peak inspiratory pressure, and nearly all (82%) survived. Infants with persistent pulmonary hypertension of the newborn had variable responses; improvement did not correlate with survival, but survival (47%) was identical to that in an earlier series of infants given tolazoline. Infants in shock had improved perfusion, urine output, and serum bicarbonate levels, and these responses were significantly related to survival. Hypertension was controlled in all three hypertensive infants. Adverse effects were very uncommon. Toxic effects were not observed. Sodium nitroprusside is effective and can be used safely in circulatory disorders in the neonate.

Cord sera were obtained from 5,006 infants. There were 135 sera with IgM values greater than 20 mg. per cent. Of these, 60 per cent probably were due to a placental leak, 13 per cent were in a questionable category, and 27 per cent were considered to be due to production of abnormal amounts of IgM in utero. Although such determinations were of some value in discovering clinically significant, inapparent congenital infections, certain premature and full-term infants with infections recognized in the immediate postnatal period had normal levels of IgM. Long-term follow-up in 27 of the 37 infants with definitely abnormal IgM in their cord serums revealed all of them to be normal.

Summary Active chronic hepatitis, confirmed by biopsy, is reported in an infant who was 10 months of age when she had the onset of recurrent jaundice, fever, and malaise. She had laboratory evidence of liver injury, hypergammaglobulinemia, and, on one occasion, hemolytic anemia. A sister of the patient died at 46 months of age and had postnecrotic cirrhosis at postmortem examination. This is the youngest patient described in the literature with active chronic hepatitis.