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Varicella is a common viral disease affecting almost the entire birth cohort. Although usually self-limiting, some cases of varicella can be serious, with 2 to 6% of cases attending a general practice resulting in complications. The hospitalisation rate for varicella in Europe ranges from 1.3 to 4.5 per 100,000 population/year and up to 10.1% of hospitalised patients report permanent or possible permanent sequelae (for example, scarring or ataxia). However, in many countries the epidemiology of varicella remains largely unknown or incomplete. In countries where routine childhood vaccination against varicella has been implemented, it has had a positive effect on disease prevention and control. Furthermore, mathematical models indicate that this intervention strategy may provide economic benefits for the individual and society. Despite this evidence and recommendations for varicella vaccination by official bodies such as the World Health Organization, and scientific experts in the field, the majority of European countries (with the exception of Germany and Greece) have delayed decisions on implementation of routine childhood varicella vaccination, choosing instead to vaccinate high-risk groups or not to vaccinate at all. In this paper, members of the Working Against Varicella in Europe group consider the practicalities of introducing routine childhood varicella vaccination in Europe, discussing the benefits and challenges of different vaccination options (vaccination vs. no vaccination, routine vaccination of infants vs. vaccination of susceptible adolescents or adults, two doses vs. one dose of varicella vaccine, monovalent varicella vaccines vs. tetravalent measles, mumps, rubella and varicella vaccines, as well as the optimal interval between two doses of measles, mumps, rubella and varicella vaccines). Assessment of the epidemiology of varicella in Europe and evidence for the effectiveness of varicella vaccination provides support for routine childhood programmes in Europe. Although European countries are faced with challenges or uncertainties that may have delayed implementation of a childhood vaccination programme, many of these concerns remain hypothetical and with new opportunities offered by combined measles, mumps, rubella and varicella vaccines, reassessment may be timely.

Unlabelled: With major advances in life-support measures, nutrition has become one of the most debated issues in the care of very low birth-weight (VLBW) infants. Current nutritional recommendations are based on healthy premature infants and designed to provide postnatal nutrient retention during the 'stable-growing' period equivalent to the intrauterine gain of a normal foetus. However, this reference is still a matter of discussion, especially in the field of the mineral requirements. After birth, there are dramatic physiological changes in bone metabolism resulting from various factors: disruption in maternal mineral supply, stimulation of calciotropic hormone secretion, change in hormonal environment and relative reduction in mechanical stress. These events stimulate the remodelling process leading to an increase in endosteal bone resorption and a decrease in bone density. In preterm infants, these adaptation processes modify the mineral requirement, since, by itself, the increased remodelling provides a part of the mineral requirement necessary for postnatal bone growth and turnover. The care of newly born premature infants should not necessarily aim to achieve intrauterine calcium accretion rates., Conclusion: Considering that a calcium retention level ranging from 60 to 90 mg/kg/day assures appropriate mineralization, and decreases the risk of fracture and diminishes the clinical symptoms of osteopenia, an intake of 100 to 160 mg/kg/day of highly bioavailable calcium salts, 60 to 90 mg/kg/day of phosphorus and 800 to 1000 IU of vitamin D per day is recommended.

Varicella is a highly contagious disease due to varicella-zoster virus (VZV) belonging to the herpesvirus family. Following infection, the virus remains latent in neural ganglia, and upon subsequent reactivation VZV may cause zoster. While mostly a mild disorder in childhood, varicella tends to be more severe in adults. Healthy individuals may develop complications such as bacterial superinfections, pneumonia or encephalitis. Varicella may be fatal, especially in neonates and in immunocompromised persons. Control of varicella can be achieved only by widespread vaccination. The purpose of this review is to summarize the impact and the concerns of an universal varicella vaccination. The vaccines are based on the attenuated Oka-strain. The positive results of extensive safety, efficacy and cost-effectiveness analyses have warranted the introduction of these vaccines in the USA in 1995 and, more recently, in Australia and in Canada. However, European countries have some concerns. At low levels of coverage, there is a possible shift of the disease in older children and adults. At high levels of coverage, without natural exposure to the wild virus, the duration of the protection against varicella in vaccinated children could wane and zoster in elderly could increase. Recent reports suggest that a booster dose or a two doses regimen would be better for adequate immunisation in childhood. Vaccines combining measles, mumps, rubella and varicella are currently under studies and would warrant a high coverage.

We report the case of a 5 1/2 month baby with an atypical pneumonia. The PCR revealed a Pneumocystis carinii pneumonia. The complementary approach failed to show any immunosuppression. We will discuss the aetiology, physiopathology and treatment of Pneumocystis carnii pneumonia, particularly in cases without immunosuppression. We will also recall the importance of this disease in AIDS.

Meningococcemia is a severe Gram negative septicemia whose mortality may be as high as 30%. It occurs more frequently in children but the proportion of teenagers is increasing in Belgium. During the past decade, a slow but sustained rise in the incidence of this illness has been noted, with a predominance of the serogroup B. We describe the symptoms, which often are poor in the early stage, the different therapies, most of them being still under investigation, and the chemoprophylaxis. Without being alarmist, the diagnosis must be considered in any child with cutaneous rash, even atypical and tachycardia.

Environmental factors, nutritional supplies, hormonal status, diseases, and treatments appear to affect postnatal skeletal growth and mineralization in VLBW infants. Compared with their term counterparts, ELBW infants are at risk of postnatal growth deficiency and osteopenia at the time of hospital discharge. From recent data, DXA is becoming one of the reference techniques to evaluate mineral status, whole-body composition, and effects of dietary manipulations on weight gain composition and mineral accretion in preterm infants. Weight gain and length increases need to be evaluated carefully during the first weeks of life, in the intensive care unit and out of it, in the step down unit. Nutritional survey is required to improve the nutritional supply and to maximize linear growth. As the critical epoch of growth extends, during the first weeks or months after discharge, follow-up and nutritional support need to be provided during the first years to promote early catch-up growth and mineralization. Further studies need to determine precisely the most optimal feeding regimen during this period but also need to evaluate the long-term implications of such a policy on stature, peak bone mass, and general health at adulthood.

Gestational diabetes, even if it seems to induce far less foetal complications than classical type 1 or type 2 diabetes mellitus, may be deleterious for the child. We will successively consider the complications that could affect the child during gestation, during the neonatal period and during adult life. These consequences for the offspring require optimal screening and management of gestational diabetes mellitus.

We report the case of a rapidly progressing respiratory failure of a three-month old infant, who shows a cardiomyopathy with left ventricule hypertrophy leading to a Pompe's disease diagnosis. This type 2 glycogenosis will be confirmed by the enzymatic study of the hepatocytes. It is a genetic pathology associated with a deficient activity of the acid maltase resulting in a intralysosomial accumulation of glycogen. The most generally responsible mutations are: delta 18 et delta 525. Prognosis is quite bad with a progressive deterioration of the heart, brain and muscular functions causing death at around 4 to 8 months. Type 2 glycogenosis may be diagnosed before birth through enzymatic study of a material collected through an amniocentesis or a biopsy on chorionic villi, and through DNA analysis. Curative treatment is still under study, but two main research orientations are being developed: genic therapy using viral vector and the correction of the enzymatic deficiency thanks to the synthesis of alpha glucosidase modified to specially get affixed to the heart and muscular cells. Both techniques have already show some encouraging results even though the clinical applications are not presently valid yet.

Objective: Evaluation of the results obtained in the management of congenital heart diseases in Liège., Material and Methods: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team., Results: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers., Conclusions: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liège appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children.

A novel measles-mumps-rubella vaccine (Priorix) has been marketed by SmithKline Beecham. It contains live attenuated virus with measles and mumps strains slightly different from those present in MMR VAX (Pasteur Merieux MSD). The indications and contraindications are similar for both vaccines. Immunogenicity is also equivalent as well as general reactogenicity. By contrast local symptoms were reported significantly less frequently after Priorix.

Cat-scratch disease is a subacute, regional lymphadenitis syndrome that occurs mainly in children. The causative agent is Bartonella henselae. After an incubation period ranging usually between 1 and 2 weeks, red papules develop at the site of cutaneous inoculation and persist until the development of lymphadenopathy with some malaise. Cases with complications have been observed including Parinaud oculoglandular syndrome, encephalopathy, a variety of exanthems and granumatous hepatitis. Diagnosis is based on serologic tests and, when necessary, antimicrobial treatment can be considered. Incision and drainage should not be done.

The reproducibility, accuracy, and precision of dual-energy X-ray absorptiometry (DXA) was assessed by scanning 13 piglets (1471-5507 g) in triplicate. In four piglets, fat content was increased with porcine lard around the abdomen; additional measurements were performed on these animals. Reproducibility in DXA measurements from the animals without added fat was 0.09% for body weight, 1.95% for bone mineral content (BMC), and 5.35% for fat content. DXA estimates of body weight, BMC, and fat content were significantly correlated with scale body weight, ash weight, chemical calcium, and chemical fat. Body weight was measured accurately but fat content was overestimated by DXA. Mean BMC estimated by DXA represented 48% of ash weight and 215% of calcium content. The precision of DXA was 0.23% for body weight, 10.99% for ash weight, and 4.44% for calcium content. The precision of DXA for fat content was poor. However, for measurements performed in piglets with > 250 g fat, the precision was 8.85%. Thirty appropriate-forgestational-age term human neonates (birth weight: 3188 +/- 217 g) were scanned once during the first week of life. BMC and fat content were 54 +/- 6 and 470 +/- 92 g, respectively, which corresponded to 26.4 +/- 2.6 g calcium and 427 +/- 82 g fat. These were close to the reference values previously determined by chemical analysis. This study suggests that DXA is accurate and reliable for measurement of calcium and fat contents in human neonates. Further refinements would be beneficial for determining fat content in preterm human infants.

Growth parameters, biochemical indice of protein metabolism and plasma Amino acid (AA) concentrations were investigated during the first month of life in term infants (n = 61) fed various protein hydrolysate formulas (whey (WHF, n = 3), soy collagen (SCHF, n = 1) and whey-casein hydrolysate formulas (WCHF, n = 1)). In addition, metabolic balance studies were performed in 10 infants fed WHF and in 5 fed WCHF. Comparatively to breast fed infants, growth reduction and decrease in plasma protein concentrations were observed with the use of one of the WHF and in a lesser extent with the SCHF and the WCHF. Plasma amino acid pattern reflected the AA content of the formulas. Whey hydrolysate formulas induced mainly an increase in threonine and a decrease in tyrosine concentrations. Soy-collagen hydrolysate formula led to an increase of non-essential amino acids, such as glycine and hydroxyproline and a decrease in plasma lysine and cystine. Whey-casein hydrolysate formula induced a plasma amino acid pattern close to the profile observed in breast fed infant. Metabolic balance studies showed a relative reduction in nitrogen absorption and utilisation in the infants fed the WHF and the WCHF. In addition a drastic reduction in fat, calcium and phosphorus absorption was also observed with the use of the WCHF. In preterm infants (n = 19) fed whey predominant hydrolysed preterm formulas (n = 3), metabolic balance studies an plasma AA concentration were evaluated at the end of the first month of life at 34 weeks of gestation age. Comparatively to similar preterm infants fed conventional preterm formulas, a relative reduction in nitrogen absorption (83% vs 90%) and retention (64 vs 70%) as well as in phosphorus absorption (78 vs 89%) was observed. Calcium retention was similar (48 vs 45 mg/kg/d) but calcium intake was significantly higher in infants fed hydrolysate formulas 120 vs 91 mg/kg/d. Plasma amino acid concentrations were related to amino acid composition of the formulas. Compared with the standard preterm formulas, all three protein hydrolysate formulas led to a significant increase in plasma threonine and a decrease in tyrosine and phenylalanine concentrations. In addition, there was a reduction in plasma histidine, valine, leucine, cystine, methionine and/or tryptophane with some of the hydrolysate formulas used. In conclusion, these studies provide evidence that protein hydrolysed formulas are not equivalent to whole protein formulas in terms of nutritional efficiency for preterm and term infants. Therefore further extensive nutritional studies on growth, biochemical indices of protein metabolism and metabolic balance, including minerals and trace elements, appear to be necessary before maintaining and promoting the use of such formulas for teh potential benefits on atopic disease in preterm and in full-term newborn infants.

We assessed the growth, tolerance, and acceptability as well as fecal flora composition and stool pH of 20 healthy full-term infants fed with a fermented whey-adapted infant formula containing viable bifidobacteria (10(6)/g of powder) during the first 2 months of life. This fermented infant formula, first biologically acidified by Streptococcus thermophilus and Lactobacillus helveticus, was compared to a whey-adapted, nonacidified, low-phosphate infant formula in a double-blind, randomized controlled study. The results were compared to a control group (n = 14) of fully breast-fed infants. The fermented whey-adapted formula containing viable bifidobacteria induced a prevalence of colonization with bifidobacteria at 1 month of age similar to that of breast-fed infants (12/20 versus 8/14) but significantly higher than in the group fed the standard infant formula (4/20). The mean bacterial count of bifidobacteria was similar in all colonized infants; however, fecal pH was significantly lower in the breast-fed infants than in the nonacidified bottle-fed infants. This kind of infant formula was well tolerated and promoted a normal growth during the first 2 months.

The aim of this study was to investigate absorption and retention of nitrogen, fat, calcium, phosphorus and magnesium, as well as plasma amino acid concentrations in 19 preterm infants fed three experimental protein hydrolysate preterm formulas (PTHF): seven received a preterm formula based on 100% whey hydrolysate protein (PTHF1), seven other infants were fed a preterm formula based on a mixture of 78% whey and 22% casein hydrolysed protein (PTHF2) and a third group of five infants were fed the same type of protein hydrolysate (78/22) enriched with histidine (PTHF3). Metabolic balances (n = 39) and plasma amino acid concentrations (n = 12) in preterm infants fed a standard preterm formula (whey/casein: 60/40) were included as a control group. Amino acid composition of the formulas was determined after complete hydrolysis with 12 N HCl. Compared with the standard preterm formula, the use of protein hydrolysate formulas led to a decrease in nitrogen and phosphorus absorption without modification of retention. Net absorption of calcium and magnesium was not significantly different in the four groups but calcium intake necessary to obtain calcium retention similar to the standard preterm formula was higher in the infants fed the hydrolysate formulas. Plasma amino acid concentrations were related to the amino acid composition of the formulas. Compared with the standard preterm formula, all three protein hydrolysate formulas led to a significant increase in plasma threonine, and a decrease in tyrosine and phenylalanine concentrations. In addition, there was an important reduction in plasma histidine concentrations with PTHF1.(ABSTRACT TRUNCATED AT 250 WORDS)

This study compared nutrient utilization and postnatal weight gain composition in eight appropriate for gestational age (AGA: birth weight 1293 +/- 107 g; gestational age 28.8 +/- 1.4 weeks) and eight symmetrically growth-retarded (SGA: birth weight 1110 +/- 230 g; gestational age 32.7 +/- 1.9 weeks), very low-birth-weight (VLBW) infants. There was no significant difference in protein, mineral and energy intake between AGA and SGA infants. Nitrogen absorption (84 +/- 3 and 83 +/- 4%) and nitrogen retention (356 +/- 48 and 352 +/- 43 mg/kg/day) were similar in both groups. Fat absorption tended to be lower in AGA (78 +/- 15%) than in SGA (87 +/- 4%) infants. Calcium, phosphorus and magnesium absorptions were similar in AGA and SGA infants. Metabolizable energy utilization was similar in both groups; about 55% was expended and 45% stored in new tissues. Energy expenditure was 58 +/- 4 kcal/kg/day in SGA infants and 61 +/- 9 kcal/kg/day in AGA infants. Weight gain and its composition were similar in both groups. We conclude that nutrient and energy utilization are similar in AGA and symmetrically growth-retarded, VLBW infants.

Fat and mineral metabolic balance studies were performed in 25 normal very low-birth-weight infants (< or = 1500 g at birth) fed either pooled pasteurized human milk supplemented with calcium, phosphorus and magnesium, or a preterm formula. Calcium, phosphorus and magnesium intake were similar in both groups and averaged 100 mg/kg/day, 72 mg/kg/day and 8 mg/kg/day, respectively. Calcium and phosphorus retention was higher in the subjects fed fortified human milk than in those receiving a preterm formula (65 +/- 14 and 62 +/- 9 mg/kg/day versus 55 +/- 12 and 47 +/- 7 mg/kg/day respectively). The difference was only significant for phosphorus. Magnesium retention was similar in the two groups and averaged 3 mg/kg/day. Fat intake and absorption was significantly higher in the preterm formula fed group than in the one fed fortified human milk (5.5 +/- 0.4 g/kg/day and 88 +/- 4% versus 4.2 +/- 1 g/kg/day, 79 +/- 6% respectively). Assessment of the whole body bone mineral content by dual energy X-ray absorptiometry was performed at 3 and 6 months of age in another group of 25 low-birth-weight infants fed either fortified human milk or a preterm formula. Whole body bone mineral content (BMCt) was low (43.3 +/- 30.8 g of hydroxyapatite) at 3 months of age (theoretical term) compared to normal full-term newborns at birth. There was no significant influence of the diet. At 6 months of age, BMCt reached 168.6 +/- 36.6 g, a value similar to that of full-term newborns, with no significant difference between the two regimen groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the study was to compare, during the first month of life, growth parameters, biochemical indices of protein metabolism and plasma amino acid concentrations in newborn infants fed either human milk (n = 23), three different whey hydrolysate formulae (WHF 1, n = 13; WHF 2, n = 10; WHF 3, n = 13), a soy-collagen hydrolysate formula (SCHF n = 18) or a whey-casein hydrolysate formula (WCHF, n = 20). Growth parameters and the various protein concentrations determined in the infants fed WHF 1 and WHF 2 were similar to the values observed with human milk. With WHF 3, growth in weight, length and head circumference and serum total protein concentrations were reduced significantly whereas blood urea nitrogen was increased. With SCHF, growth in weight and length as well as serum total protein and transferrin concentration were decreased significantly, whereas serum IgG concentration was increased. With WCHF growth in length and serum transferrin concentration were decreased compared to the human milk group. In the various groups, the plasma amino acid pattern reflected the amino acid content of the formula. Whey hydrolysate formula induced mainly an increase in threonine and a decrease in tyrosine concentrations. Soy-collagen hydrolysate formula led to an increase of non-essential amino acids, such as glycine and hydroxyproline, and a decrease in plasma lysine and cystine. Whey-casein hydrolysate formula induced a plasma amino acid pattern close to the profile observed with human milk. Nevertheless, the plasma concentrations of most of the various amino acids were higher.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the study was to compare growth parameters, biochemical indices of protein metabolism and plasma amino acid concentrations in infants fed either human milk (n = 12) or a whey protein hydrolysate formula (n = 13) during the first month of life. Growth and gain in skin fold thickness were similar in both groups whereas serum protein concentration was significantly decreased (57.4 +/- 3.9 versus 61.2 +/- 2.9 g/l) in the infants fed the whey hydrolysate formula. The discrepancies between the plasma amino acid pattern of the whey hydrolysate formula group and that of the human milk group lessened during the first month. Nevertheless, at a mean age of 33 days the plasma threonine concentration remained twice as high and the plasma tyrosine, phenylalanine and proline concentrations were significantly lower in the whey hydrolysate formula group than in the human milk group. Thus, compared with breast-fed infants, growth and most of the biological indices of protein metabolism were satisfactory in infants fed during the first month of life on a whey protein hydrolysate formula. Nevertheless, the decrease in total plasma protein concentration needs to be confirmed in a larger cohort of infants. In addition, further research is necessary to investigate the possible ways of reducing the hyperthreoninemia and preventing other plasma amino acid disturbances since it would be desirable to obtain plasma amino acid levels similar to those of breast-fed infants.

High frequency ventilation (HFV) has been used by the authors for about 5 years in low-weight premature neonates with severe hyaline membrane disease. This retrospective study concerns principally three classes of results: 1) early results of HFV vs conventional ventilation; 2) middle term results, HFV having been used in most severe cases; 3) long term outcome: HFV might prevent efficiently delayed complications such as bronchotracheal dysplasia. Recent therapy developments (surfactant, new ventilators) require controlled prospective studies to assess the real benefits of HFV compared with conventional methods.

Net calcium absorption was evaluated in 103 low-birth-weight preterm infants by a 72-h balance technique. At birth the infants had a mean (+/- SE) gestational age of 30.9 +/- 0.2 wk and weighed 1.43 +/- 0.03 kg. When tested 3 wk later, their net calcium absorption averaged 58 +/- 1% with an intake of 80 +/- 2 mg Ca.kg body wt-1.d-1. Of the 103 infants, 58 had been fed low-birth-weight formulas supplemented with vitamin D. The remainder received banked human milk, of whom 34 were supplemented with vitamin D and calcium; 11 infants received no supplementation. Calcium absorption in the four subgroups did not differ significantly, with neither vitamin D supplementation nor supplementation with vitamin D and calcium affecting percent absorption significantly. Net calcium absorption was a linear function of intake (40-130 mg Ca.kg body wt-1.d-1) with a zero intercept. Because vitamin D supplementation did not increase net calcium absorption, it is concluded that in preterm low-birth-weight infants calcium absorption proceeds by a nonsaturable route, with the transcellular, vitamin D-regulated mechanism not yet expressed.

Inadequate low intake of phosphorus can induce a hypophosphatemic depletion syndrome resulting in hypercalcemia, hypercalciuria, hypophosphatemia, and rickets. Tubular reabsorption for phosphate per liter glomerular filtration rate (TP/GFR) has been proposed as a reliable index of renal phosphate handling for all age groups. In the present study, carried out in 12 healthy premature babies fed unmodified pooled human milk and then a preterm formula for two periods of 10 days, we demonstrated clearly that TP/GFR as well as calciuria can reflect the poor phosphorus intake and that the kidney of preterm babies is able to rapidly adapt itself to an increase in phosphorus diet content.

Heat processing is essential for the preservation of milk-based infant formulas. Heating, however, induces a number of chemical changes during which lysine in the milk proteins reacts with reducing sugars to form Maillard reaction products (MRPs) and also reacts with the dehydroalanine resulting from cystine degradation to form lysinoalanine (LAL). Both products have been reported to induce histological changes in the straight portion of the proximal tubule in the rat kidney. This pilot study was made to investigate the urinary excretion by healthy preterm babies of MRPs and LAL contained in infant formula and to determine their influence on kidney function. Twelve healthy male preterm babies were first fed for 10 days with pooled human milk and then for 5 days with each of two experimental premature infant formulas in a cross-over design. The infant formulas were sterilized either by ultra-high temperature (UHT) treatment or by a conventional retort process to give products with low and high levels of MRPs and LAL, respectively. In total, some 15.6% of the initial lysine had been modified in the in-can-sterilized product, compared to 6.2% in the UHT product. Urinary excretion of MRP lactulosyllysine ranged from 1.3 to 3.9% of the ingested amount, whereas that of LAL ranged from 6.2 to 9.3%. The higher level of MRPs and LAL in the formulas compared to breast milk had no influence on creatinine clearance or electrolyte excretion. There was no evidence of tubular damage as determined by the urinary excretion of four kidney-derived enzymes. Feeding of formula, however, did result in a general increase in urinary microprotein levels.(ABSTRACT TRUNCATED AT 250 WORDS)

The anti-infectious role of human milk may be, at least partly, ascribed to its content in secretory IgA. As lectins are present in various infectious antigens, the binding of different types of IgA to three lectins (concanavalin A, peanut agglutinin, wheat germ agglutinin) was studied by Elisa. The specificity of those bindings was assessed by inhibitory experiments performed with the corresponding oligosaccharides. The following were found for the three lectins: (1) the lectin-binding capacity of colostrum secretory IgA was markedly greater than that of normal plasma IgA1 (p less than 0.001); (2) the lectin-binding capacity of polymeric IgA1 was greater than that of monomeric IgA1 (p less than 0.001). This property of mucosal IgA may be responsible of a nonimmune opsonization able to prevent the early step of some infectious mucosal diseases, i.e. the attachment of bacteria to epithelial cells by lectin-like bonds and also the penetration into the body of some antigens able to favor the development of allergy. Milk mucosal IgA, present in significant amounts in human colostrum and mature milk - but not in infant formulas - may therefore play an important polyvalent protective role in newborns.

We performed metabolic balance studies in 77 preterm infants fed on human milk or adapted formulas, to determine the renal solute load and compared it with the potential renal solute load estimated by the composition of the diet or the urine according to Ziegler's, Bergman's, and Shaw's calculations. The renal solute load found in preterm infants was lower than that observed in young full term infants. Although all calculations predicted the renal solute load well, the equation proposed by Ziegler and Fomon from dietary protein and electrolyte load appears to be the simplest to calculate renal solute load accurately in preterm infants.

Atracurium is a neuromuscular blocking agent that spontaneously degrades by Hoffmann reaction. This study of a prolonged infusion (7 days) in an infant of 6 months shows an increase in infusion rate requirement from 0.7 mg/kg/h after 96 h of infusion to 1.8 mg/kg/h at the 7th day. The plasma laudanosine levels remained relatively constant (977-1,515 ng/ml) and well below the reported potent convulsive levels during the study despite a 3-fold increase in the atracurium requirement. No side effect or accumulation of the drug was observed. The reasons for the increase in atracurium requirement are discussed.

We describe a child with multiple congenital anomalies born to a women treated with valproic acid (1000 mg/day) for post traumatic epilepsy. Defects included the typical dysmorphism of the "fetal valproic syndrome", bilateral radial ray aplasia, unilateral proximal phocomelia of the upper limb, kidney hypoplasia and brain atrophy. A direct teratogenic effect of valproic acid is suspected on an experimental basis, and validated by two previous reports of radial defects after valproic acid exposure.

Fat, phosphorus, and calcium balance studies were performed in normal very low birth weight infants (BW less than or equal to 1,500 g) fed either normal or calcium- and phosphorus-supplemented pooled pasteurized human milk. Calcium and phosphorus supplements were 27 mg/dl and 24.5 mg/dl, respectively, throughout the study. Measured calcium and phosphorus intake in the supplemented group averaged 90 +/- 6 mg/kg/day and 62 mg/kg/day, respectively, compared to 47 +/- 7 mg/kg/day and 24 +/- 6 mg/kg/day in the nonsupplemented group. The percent of fat, calcium, and phosphorus absorption was similar in the two groups: respectively, 71 +/- 23%, 73 +/- 13%, and 93 +/- 2% in the supplemented group compared to 75 +/- 11%, 71 +/- 14%, and 92 +/- 4% in the nonsupplemented group. Calcium and phosphorus retention reached 62 +/- 12 mg/kg/day and 53 +/- 4 mg/kg/day in the supplemented group against 21 +/- 10 mg/kg/day and 21 +/- 5 mg/kg/day in the nonsupplemented group. These data support the notion that calcium, in addition to phosphorus supplementation in pooled human breast milk, improves both calcium and phosphorus retention in preterm infants.

The objectives of this paper are (1) to describe the organization of neonatal care in Belgium; (2) to review evaluative studies aiming at assessing the availability, effectiveness and cost of care, and (3) to compare the situation in Belgium with that in other countries. In the future, basic neonatal care should be provided in each maternity unit. This means that many maternities need upgrading in staffing and equipment. For intensive care, there is only a need for 10-12 specialized centers in the country. A policy for rapid transfer of sick neonates to specialized centers should be implemented.

An unusual case of Caffey-Silverman's disease with thrombocythemia and increased type M immunoglobulins and C-reactive protein levels is reported. These particularities were rarely reported in the literature. These conditions suggest that control should be exercised before steroid treatment in view of the known thrombocythemic effect of the drug. These hematologic abnormalities suggest that this syndrome is infectious in origin and emphasize the risk of steroid treatment.

Serum threonine concentration was determined during the first month of life in 163 low birthweight infants fed on either human milk, various adapted formulae, or total parenteral nutrition. On the pooled data, a significant positive relationship was found between the serum threonine concentration and threonine intake. However, the increase of the serum threonine level is more marked in the infants with the lowest actual gestational age; with a high threonine intake, the most premature infants have serum threonine levels twice as high (58.1 vs 31.7 microM/dl) as term infants. Therefore, threonine metabolism seems to be impeded in preterm infants. Considering the cord blood concentration of threonine (26.8 +/- 5.1 microM/dl) and the possible hazardous effect of hyperthreoninemia, it is suggested that threonine intake should not exceed 1200 microM (143 mg)/kg bodyweight/day in premature infants and that the amino acid composition of the diet should probably be modified in order to satisfy their protein requirement.

Growth, protein, and energy balances were studied in two groups of very-low-birth-weight premature infants fed pooled pasteurized human milk (HM) or a preterm formula (PF). Each infant was studied at 33 and 36 weeks gestational age with a combined technique of nutrient balance and indirect calorimetry measurement. Weight and length gains were higher with PF than with HM, but head circumference growth was similar with both milks. Although the volume of milk given was lower, energy intake was higher with PF than with HM in both studies (126 to 130 vs 103 to 109 kcal/kg/day). Percentage of energy absorbed was better with PF than with HM (94% vs 84%) at 33 weeks, and similar (95%) with both milks at 36 weeks. Energy expenditure, which had increased from 33 weeks to 36 weeks, was higher with PF than with HM (57 to 63 vs 46 to 52 kcal/kg/day) during both studies. Energy retention accounted for about 50% of energy absorbed with both milks, but was higher with PF than with HM (60 vs 40 to 50 kcal/kg/day) in both studies, and resulted in fat accretion well above that seen during intrauterine growth for both milks in both studies. Protein intake was higher with PF than with HM (3.1 vs 2.4 gm/kg/day) in both studies, giving a protein accretion similar to the intrauterine accretion with PF (2.2 gm/kg/day), but lower with HM. Our results suggest that the nutritional value of pooled pasteurized human milk for VLBW infants should be reconsidered, especially because of its low protein content, and that energy density of preterm formulas must be questioned in view of elevated fat deposition.

Serum diamine oxidase (DAO) activities were measured in 9 pregnant women and in 33 neonates during the 1st week of life. The radiometric method was used. Very high values were found in the mothers (mean +/- SE: 720 +/- 143 pmol ml-1 h-1). Neonates showed significantly elevated values (mean +/- SE: 178 +/- 54 pmol ml-1 h-1) on the 1st postnatal day when compared to the 7th day values (mean +/- SE: 27 +/- 5.7 pmol ml-1 h-1). Serial determinations showed a progressive decline from day 1 to day 7 after birth. We suggest the high serum DAO levels in neonates during the first days of life are due to leakage of placental enzyme into the circulation either at birth or during fetal life. Consequently, serum DAO cannot be used as a marker of small bowel functional integrity in the 1st postnatal week.

Nutritional studies frequently take into consideration plasma amino acid concentrations in order to evaluate the adequacy of protein intake in preterm infants. From our data of more than 100 determinations of plasma amino acid concentrations in preterm infants, we review the factors influencing the aminogram. Method and moment of sampling, protein intake and composition, protein turnover rate, energy supply, and gestational age, all may influence plasma amino acid concentrations. It is suggested that the cord blood amino acid concentration may be considered as an appropriate value of reference and a safe level for growing preterm infants.