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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.

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.

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.

Growth and nitrogen and energy balances were studied with a combined technique of nutrient balance and indirect calorimetry measurement in two groups of eight very low birth weight infants fed pooled pasteurized human milk (HM) or cow's milk casein hydrolysate supplemented HM (HM-Pr). There was no difference in the amount of energy absorbed (91 +/- 17 kcal/kg/day with HM-Pr versus 95 +/- 8 with HM-P) or in the growth rate. The infants fed HM-Pr had a higher nitrogen intake (602 +/- 80 versus 395 +/- 64 mg/kg/day; p less than 0.001), urinary nitrogen excretion (160 +/- 64 versus 78 +/- 16 mg/kg/day; p less than 0.005) and nitrogen retention (326 +/- 32 versus 252 +/- 48 mg/kg/day; p less than 0.01). They also had increased plasma concentrations of essential amino acids, urea nitrogen, and total protein without metabolic imbalance. Energy expenditure was higher (58 versus 49 kcal/kg/day; p less than 0.005) and energy storage lower (33 versus 47 kcal/kg/day; p less than 0.05) with HM-Pr. In percent of weight gain, protein and fat accretion represented 12 and 14% in HM-Pr group versus 10 and 27% in HM group. Very low birth weight infants fed casein hydrolysate supplemented pooled HM achieved a growth rate and a weight gain composition similar to the fetus.

In this report we present a malformed female newborn with partial trisomy 20q who was the unbalanced product of a paternal 8p/20q translocation (46,XY,t(8;20) (p23.1;q11].

For five days, three groups of six premature infants each were fed human milk and given a daily dosage of one of the following: vitamin D3 (30 micrograms), 25-OH D3 (10 micrograms) and 1,25-OH D3 (0.5 micrograms). The infants in the groups were matched for gestational age and birthweight. Administration of 25-OH De or 1,25-(OH)2 D3 did not significantly modify the course of early neonatal hypocalcemia as compared with infants receiving vitamin C3. Mean plasma Ca +/- S. D. (mg/100 ml) decreased to nadir values at 48 hr (D3: 5.7 +/-1.2; 25 OH D3: 6.8 +/- 0.9; 1.25-(OH)2 D3: 6.7 +/-1.1). A progressive increase toward normal values was seen at 120 and 168 hr in the three groups. Mean plasma immunoreactive parathyroid hormone +/- S.D. (microliters Eq/ml) followed an opposite pattern with peak values at 48 hr (D3: 231 +/- 137; 25-OH D3: 281 +/- 138; 1,25-(OH)2 D3:211 +/- 149). Mean plasma +/- S.D. 25-OH values (ng/ml) were low at 1.2 hr (8.7 +/- 4.8) n: 16) and increased significantly after 7 days of D3 (18.2 +/- 4.2 P less than 0.001) and 25-OH D3 administration (46 +/- 10.3 P less than 0.001)/Mean plasma iCT +/- S.D. (pg/ml) reached peak values at 24 hr (D3: 457 +/- 186; 25-OH D3: 415 +/- 121; 1.25-(OH)2 D3: 443 +/- 183). These data suggest that the various forms of vitamin D are well absorbed in preterm infants and that administration of vitamin D metabolites during the first days of life is not warranted for they prophylaxis of early neonatal hypocalcemia.

We report about two sibs showing a common pattern of birth defects, with a pedigree suggestive of autosomal recessive heredity. The main features are intrauterine growth failure with very low birthweight; disproportionate dwarfism with predominantly distal shortening of limbs; small cubitally inclined clenched hands; microcephaly with Seckel-like facies and delayed psychomotor development. X-ray findings include metaphyseal flare, V-shaped femoral metaphyses and bowing of forearms. Primordial microcephalic osteodysplastic dwarfism Type II is discussed. Metabolic and nutritional data are presented and discussed.

Significant production of breath hydrogen has been shown in premature infants, suggesting limited intestinal capacity for digestion of carbohydrate. To evaluate net absorption of carbohydrate 24 three day balance studies were carried out in seven preterm infants fed pasteurised banked human milk and in 17 preterm infants fed a formula containing 75% lactose and 25% glucose polymers. Because carbohydrate reaching the colon may be converted to organic acids by bacterial flora, carbohydrate net absorption was determined by quantitating the faecal excretion of energy derived from carbohydrate. The carbohydrate derived energy content of milk and stools was calculated as the difference between the measured gross energy and the sum of energy related to nitrogen and fat. Faecal loss of carbohydrate derived energy was lower in the group fed formula (1.9 (SD 1.2) kcal/kg/day) than in the group fed human milk (4.0 (SD 1.8) kcal/kg/day). Net absorption of carbohydrate derived energy was 97.0 (SD 1.9)% as opposed to 92.6 (SD 3.9)%, respectively. Within each group there was no significant relation between carbohydrate energy absorption and fat, nitrogen, or gross energy absorption. Thus, although less complete with human milk than with formula, apparent absorption of energy derived from carbohydrate seemed quite satisfactory in these preterm infants.