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In the Netherlands screening of child abuse is obligatory at emergency departments. In spite of the modest detection rate, in our opinion there is sufficient evidence and reason to continue screening.

Carnitine plays a key role in the oxidation of fatty acids. Most solutions for parenteral nutrition do not contain carnitine. Because endogenous carnitine synthesis is insufficient in newborns, they are prone to developing a carnitine deficiency when they are dependent on total parenteral nutrition (TPN). Stimulated by the clinical observation of manifest clinical symptoms of carnitine deficiency in one patient, a study of 13 consecutive neonates who received TPN for over 2 weeks was begun. Their plasma carnitine levels before and during carnitine supplementation were determined. All patients had a carnitine intake far below the recommended minimal need of 11 mumol/kg per day. Although only three of them clearly showed clinical symptoms described as carnitine deficiency, carnitine supplementation for all neonates receiving TPN for over 2 weeks is recommended.

The short bowel syndrome is a clinical picture, consisting of malabsorption and failure to thrive, in consequence of a resection of more than 50% of the small bowel, with or without resection of a part of the colon. The etiology, pathophysiology, treatment and natural history are discussed, as well as complications and ultimate prognosis. A review of the literature and own retrospective investigation prove, that after an extensive small bowel resection in the neonatal period, normal stools, growth and development can occur in 1-3 years. In the first, postoperative period however, these patients suffer from considerable malabsorption, deficiencies of vitamins and trace elements, as well as complications of total parenteral nutrition and recurrent infections.

In a retrospective study of 16 patients with (congenital) bowel pathology, aged 2 to 12, attention was paid to the psychosocial aspects of the short bowel syndrome. Parents were interviewed and parents' and teachers' reports of children's behavioural and emotional problems were obtained. Parents as well as children appeared to have reached a reasonable level of adjustment. Parents' emotions concerning the period of hospitalisation still appeared to be strikingly strong. Although most children did not show obvious psychopathology, problems were observed in the areas of behaviour and attention, interfering with optimal school functioning in the case of some children.

Bowel resection during the neonatal phase of life may be associated with considerable morbidity, both short- and long-term. A retrospective evaluation is reported, concerning 74 patients who underwent bowel resection over a ten-year-period, due to necrotising enterocolitis, atresia, volvulus or Hirschsprung's disease. The cause of death of 15 non-survivors was investigated and the pattern of morbidity of 59 surviving patients was evaluated regarding growth, nutrition and defaecation. It was concluded that the ultimate prognosis for most patients is good, despite considerable morbidity during the first year of life, involving serious losses of fluids and electrolytes, cholestasis, and recurrent sepsis due to central venous catheters.