In a recent issue of the journal, Ng et al.
described the endoscopic view of an
congenital epiglottic cyst. We report the recently discovered antenatal vallecular cyst (VC). [1]
The incidence of VC is low.[2] We discovered this case of
congenital VC at 25 weeks of gestation, diagnosed on routine
ultrasound survey for polyhydramnios. An axial scan of the
oropharyngeal region showed a cystic mas...
In a recent issue of the journal, Ng et al.
described the endoscopic view of an
congenital epiglottic cyst. We report the recently discovered antenatal vallecular cyst (VC). [1]
The incidence of VC is low.[2] We discovered this case of
congenital VC at 25 weeks of gestation, diagnosed on routine
ultrasound survey for polyhydramnios. An axial scan of the
oropharyngeal region showed a cystic mass (35 x 30 mm) that
appeared to be intimately attached to the base of the tongue,
and a colour Doppler study showed that there was no
neovasularisation. A diagnosis of VC was
suggested. At 33 weeks, on the basis of an important
polyhydramios, a caesarean section was carried out. Just after birth, the baby could not cry. The cyst was partly
drained with a syringe and the airway was stabilised with
intubation. Marsupialisation of the VC using nasotracheal
intubation was performed on the 10th of life.
An awareness of the existence of VCs is important because they
can cause upper airway obstruction.[3] The widespread use of
prenatal ultrasound can lead to an earlier diagnosis of a VC and
allows for appropriate counselling and preparation at
delivery and for the proper preparation of staff and
equipment in the management of these neonates.[4,5] It allows the obstetrician to collaborate with the neonatologist,
paediatric surgeon, and paediatric otolaryngologist in order to
plan for perinatal management. It also allows an explanation to
be given to the parents, the time and place of delivery to
be decided, and planning for resuscitative efforts to be
organised in advance.
References
(1) Ng SK , Abdullah VJ, van Hasselt CA. Congenital epiglottic cyst. Arch Dis Child Fetal Neonatal Ed 2002;86:F134.
(2) Amagasu M, Lee D, Bluestone CD. Imaging quiz case
one. Vallecular cyst. Arch Otolaryngol Head Neck 1999;125:592-5.
(3) Myer CM. Vallecular cyst in the newborn. Ear Nose
Throat J 1988;67:122-4.
(4) Gluckman PG, Chu TW, Van Hasselt CA. Neonatal
vallecular cysts and failure to thrive. J Laryngol Otol 1992;106:448-9.
(5) Oluwole M. Congenital vallecular cyst: a cause of
failure to thrive. Br J Clin Pract 1996 Apr-May;50(3):170.
We read with interest the findings of Wolke et al.[1] regarding maternal
satisfaction with routine examination of the newborn. Whilst appreciating
their conclusions and those reached by others (Lee TWR et al.[2] and Walker
D[3])we wish to provide further comment.
Perhaps an equally valuable study
would be one which explores the attitudes of senior house officers to
performing this examinat...
We read with interest the findings of Wolke et al.[1] regarding maternal
satisfaction with routine examination of the newborn. Whilst appreciating
their conclusions and those reached by others (Lee TWR et al.[2] and Walker
D[3])we wish to provide further comment.
Perhaps an equally valuable study
would be one which explores the attitudes of senior house officers to
performing this examination and assessing the perceived benefits to their
professional development. Possible questions may include:
(i) Did you receive formal training from a senior paediatrician?
(ii) Do you feel comfortable performing this task and subsequently
reassuring parents about their infant?
(iii) Do you feel competent to discuss aspects of general neonatal care
and education with parents?
(iv) Do you think this task contributes positively to your training?
It is important to note that whilst not subjecting senior house
officers to vast numbers of repetitive neonatal examinations, a formal
system of training in all aspects of routine neonatal care followed by
subsequent assessment might be educationally beneficial. It is surely
questionable to expect paediatric senior house officers to progress to GPs
and higher specialist trainees managing common problems in newborn infants if their
previous experience is being reduced further. The correct balance between
education and service provision is essential to prevent future
deficiencies in general paediatric knowledge.
Guy C Millman
Prakash Satodia
References
(1) Wolke D, Dave S, Hayes J, Townsend J, Tomlin M. Routine examination of the newborn and
maternal satisfaction: a randomised controlled trial. Arch Dis Child
Neonatal Fetal Ed 2002;86:F155-60.
(2) TWR Lee, R E Skelton, and C Skene. Arch Dis Child Fetal Neonatal Ed 2001;85:F100-4.
(3) Walker D. Role of routine neonatal examination. It probably makes
more sense for other staff to carry out neonatal examinations [letter].
BMJ 1999;318:1766.
Armstrong and Simpson’s letter in May’s edition of Archives of Disease in Childhood highlights the difficulties encountered by junior medical staff when examining the
neonatal palate.[1] Their concern is echoed by a presentation at the recent Royal
College of Paediatrics and Child Health spring meeting. Habel et al. presented the
results of their audit revealing that 31 % of isolated cleft pal...
Armstrong and Simpson’s letter in May’s edition of Archives of Disease in Childhood highlights the difficulties encountered by junior medical staff when examining the
neonatal palate.[1] Their concern is echoed by a presentation at the recent Royal
College of Paediatrics and Child Health spring meeting. Habel et al. presented the
results of their audit revealing that 31 % of isolated cleft palate (ICP) cases over a ten-year period were missed in the first 24 hours.[2] Neither of these authors describe the
circumstances of the routine neonatal examination.
It is recommended that the examination be performed under direct vision with a torch
and spatula. Our experience is that this is only possible if the paediatrician performs the examination with an assistant. We discovered this when we introduced a clinic
setting for all weekday routine neonatal examinations to overcome the problems
created by early maternity discharges. The paediatric Senior House Officer is assisted
by a nurse whom can then support the baby’s head with the neck extended whilst
placing a finger on the baby’s chin. The paediatrician is then able to examine the
whole palate without difficulty with torch and spatula. Examinations not performed in
the clinic setting, usually at the weekend, encounter the difficulties described by
Armstrong and Simpson. Failing in the neonatal examination can result from the
circumstances in which it is performed rather than the examination itself.
Christopher S. James
Peter J. Todd
Department of Paediatrics
Arrowe Park Hospital
Arrowe Park
Wirral CH49 5PE
UK
References
(1) H Armstrong and R M Simpson. Examination of the neonatal palate. Arch Dis Child Fetal Neonatal Ed 2002;86:F210.
(2) Habel A, Elhadi N, Sommerlad B. Delay in detection of cleft palate, an audit of newborn clinical examination. Arch Dis Child 2002;86(suppl 1):A59.
We read the article by Reece et al [1] and closely followed the responses
to it. We even went ahead to carry out a study looking at identification
of the tip of the long lines using inversion of image technique on PACS
(picture archiving and communication system).
Background: Positioning of long lines into the heart has serious
consequences including death due to cardiac tamponade.[2] The...
We read the article by Reece et al [1] and closely followed the responses
to it. We even went ahead to carry out a study looking at identification
of the tip of the long lines using inversion of image technique on PACS
(picture archiving and communication system).
Background: Positioning of long lines into the heart has serious
consequences including death due to cardiac tamponade.[2] The tip of long
lines is accurately visible in only 50 % of plain radiographs.[1]
Identification of the line using radio opaque contrast media requires
caution. The use of an insufficient volume of contrast will falsely
identify the tip in an apparently more proximal position, whereas a film
taken during active injection may cause the line to appear longer due to a
jet of contrast issuing from the tip of the line. Bernard I and Banerjee
I, from Glan Clwyd Hospital, wrote in their E-letter on the use of PACS in
their hospital to identify the tip of the long lines.[3] Ultrasound may be
of value but it requires expertise to perform and interpret.[2]
Methods: At Hinchingbrooke Hospital, Huntingdon, X-rays are taken on a
phosphor plate which are later processed through PACS and image is
available on computer terminal on the Special care baby unit. The Hospital
use Frame wave dicom view version 3.0 software that allows for image
inversion, image magnification and image sharpening. Using the technique
of image inversion supplemented by image magnification and sharpening of
image, the tips of the long line are much better seen than on plain X-rays. Our this observation lead us to carry out a study looking at the
tips of the long lines on plain X-ray and then on the same image on PACS
with image inversion. Three investigators including an experienced SHO, a
consultant paediatrician and a consultant neonatologist participated in
this study. The study was retrospective and included the long lines
inserted between the periods of January 2000 to July 2001.
Results:
Observer
Tip visible on plain X ray
Tip visible on inverted image
Improvement
A
06/24 (25%)
15/24 (63%)
38%
B
12/23 (52%)
17/23 (74%)
22%
C
40/69 (58%)
65/69 (94%)
36%
Conclusions: Inversion of image on PACS is better than plain
radiograph in identifying the tip of the long lines. Although there is
inter observer variation, with experience of using PACS, this may be
minimized. It is important to note that there is improvement in
recognition of line tip by each observer.
Recommendations: We recommend that units having facility of PACS should
use them to identify the long line tips and there is a need for
prospective randomized study comparing contrast study v/s image inversion
technique on PACS, before accepting contrast as the only way of
identifying the tips of long lines.
Other uses of PACS with regards to neonatal long lines:
1. Accurate line manipulation. Once it is noted that the long line is in
right atrium, one can measure the distance on the image by which it should
be pulled back to be in acceptable place, rather than guessing the
distance by which line is pulled back.
2. Monitoring of long line on subsequent X rays: Most unit that uses
contrast to identify the long line tip does it only once to confirm the
position and subsequently look at the plain X rays (taken for other
clinical indications) to see the long line position. We know that long
lines do migrate over a course of time and plain X rays are less sensitive
to detect the tip accurately. The use of PACS allows each image to be
reviewed with same accuracy as first image. This can detect the potential
line migration and allows adjustments in line position to be made.
References
(1)Reece A et al. positioning long lines: contrast versus plain
radiography. Arch Dis Child Fetal Neonatal Ed 2001; 84:F129-30.
(2) Review of four neonatal deaths due to cardiac tamponade associated with
the presence of a central venous catheter: Recommendations and department
of health response. June 2001.
(3) Bernard I, Banerjee I. E-letter. Arch Dis Child 14th May 2001.
I am familiar with the work of Dr Shehadeh et al. There may indeed
be a place for insulin in infant formula. However, before such a step is
taken, I believe that it is imperative that appropriate prospective
studies be done, including safety monitoring. Although our human pilot
study and animal studies suggest there may be a benefical effect of oral
insulin, much more work needs to be done...
I am familiar with the work of Dr Shehadeh et al. There may indeed
be a place for insulin in infant formula. However, before such a step is
taken, I believe that it is imperative that appropriate prospective
studies be done, including safety monitoring. Although our human pilot
study and animal studies suggest there may be a benefical effect of oral
insulin, much more work needs to be done and recommending its use now is,
to my mind, not appropriate. [1]
Reference
(1) RJ Shulman. Effect of enteral administration of insulin on intestinal development and feeding tolerance in preterm infants: a pilot study. Arch Dis Child Fetal Neonatal Ed. 2002;86:F131-3.
I read with great interest the article by Shulman.[1] Indeed, orally
administered insulin may have a positive effect on gut maturation and
mucosal enzyme expression in preterm infants. We have recently
demonstrated that human milk is rich in insulin (mean = 60.2 micro U/ml),
and that insulin is barely detected in infant formulas.[2] Moreover, we
have hypothesized that insulin content of human milk may ha...
I read with great interest the article by Shulman.[1] Indeed, orally
administered insulin may have a positive effect on gut maturation and
mucosal enzyme expression in preterm infants. We have recently
demonstrated that human milk is rich in insulin (mean = 60.2 micro U/ml),
and that insulin is barely detected in infant formulas.[2] Moreover, we
have hypothesized that insulin content of human milk may have an important
role in the primary prevention of type 1 diabetes, by inducing active
cellular machanisms that suppress the development of autoimmune diabetes,
and by reducing intestinal transmission of 'triggering' dietary peptides.[3]
We suggest to add human insulin to infant formulas in a concentration
similar to insulin concentration present in human milk. This addition may
lead to the following beneficial effects: It will make infant formula
similar to human milk; it may fasten gut maturation; and it may protect
from the development of type 1 diabetes.
References
(1) Shulman RJ. Effect of interal administration of insulin on
itestinal development and feeding tolerance in preterm infants: a pilot
study. Arch Dis Child Fetal Neonatal Ed 2002;86:F131-3.
(2) Shehadeh N, Gelertner L, Blazer S, Perlman R, Solovachik L, Etzioni
A. Importance of insulin content in infant diet: suggestion for a new
infant formula. Acta Pediatr 2001;90:93-5.
(3) Shehadeh N, Shamir R, Berant M, Etzioni A. Insulin in human milk
and the prevention of type 1 diabetes. Pediatric Diabetes 2001;2:175-7.
I read with interest the report by Al-Dahhan and colleagues on the
beneficial effect of NaC1 supplementation of preterm infants during the
neonatal period on their later neurodevelopmental outcome. They found
better memory, learning, language and educational performances at the age
of 10-13 years in prematures who were given 4-5 mMol/day NaC2 when
compared to those not receiving NaC1 supplement.[1] In th...
I read with interest the report by Al-Dahhan and colleagues on the
beneficial effect of NaC1 supplementation of preterm infants during the
neonatal period on their later neurodevelopmental outcome. They found
better memory, learning, language and educational performances at the age
of 10-13 years in prematures who were given 4-5 mMol/day NaC2 when
compared to those not receiving NaC1 supplement.[1] In this regard, it is
relevant to mention our most recent findings describing a new aspect of
the relationship of neonatal sodium homeostasis to central nervous system
function. Namely, we demonstrated that hyponatraemia is one of the most
significant risk factors for development of sensorineural hearing
impairment detected by transient evoked otoacustic emission and confirmed
by auditory brainstem response.[2]
In addition, I consider their report raises an important clinical
issue, in that I regard their selection of list of references as
subjective and arbitrary. In particular, the work of our group in revealing
some major features of sodium homeostasis in premature has been ignored;
for example wasting, sodium depletion and hyponatraemia, [3,4,5] and the
first introduction of NaC1 supplementation in a dose of 3-5 mM/kg/day to
prevent sodium deprivation, to improve somatic stability and to avoid
untoward clinical consequences.[6]
Endre Sulyok MD
Professor & Chairman
County Children's Hospital, Institute of Health Promotion and Family Care
Faculty of Health Sciences, University of Pecs
H-7624 Pecs, POB 76, Hungary
References
(1) Al-Dahhan, Jannoun L, Haycock GB. Effect of salt supplementation of newborn premature infants on neurodevelopmental outcome at 10-13 years of
age. Arch Dis Child Fetal Neonatal Ed 2002;86:F120-F123.
(2) Ertl T, Hadzsiev K, Vincze O, Pytel J, Szabó T, Sulyok E. Hyponatraemia and sensorineural hearing loss in preterm infants.
Biol Neonate 2001;79:109-12.
(3)Sulyok E.
The relationship between electrolyte and acid-base balance in the premature infant during early postnatal life.
Biol Neonate 1971;17:227-37.
(4) Sulyok E, Heim T, Soltész G, Jászai V.
The influence of maturity on renal control of acidosis in newborn infants.
Biol Neonate 1972;21:418-35.
(5) Sulyok E.
Sodium homeostasis in preterm infants.
Lancet, 1975;I:930 (letter).
(6) Sulyok E, Németh M, Tényi I, Csaba IF, Varga L, Varga F.
Relationship between the postnatal development of the renin-angiotensin-aldosterone system and
electrolyte and acid-base status of the NaCl supplemented premature infants.
In: The Kidney during Development Morphology and Function. Edited by Spitzer A.
Masson Publishing, New York 1982;273-281.*
*This paper was presented in 1980 in the First International Workshop on Developmental Renal
Physiology organized by A. Spitzer in New York
Me thinks Professor Sulyok doth protest too much. His early,
pioneering work on electrolyte balance in the newborn is well known (and
extensively cited in an earlier review of the subject co-authored by
myself.[1] In this, inter alia, his study of the effect of salt
supplementation on the renin-angiotensin-aldosterone system [2] is quoted in
support of the hypothesis that hyponatraemia in premature infant...
Me thinks Professor Sulyok doth protest too much. His early,
pioneering work on electrolyte balance in the newborn is well known (and
extensively cited in an earlier review of the subject co-authored by
myself.[1] In this, inter alia, his study of the effect of salt
supplementation on the renin-angiotensin-aldosterone system [2] is quoted in
support of the hypothesis that hyponatraemia in premature infants is due
to salt depletion rather than water retention). The reason these papers
were not cited in the present paper is that they are not relevant to it.
The paper is not a historical or general review of hyponatraemia in the
newborn but the results of a study specifically designed to examine
neurodevelopmental outcome in two particular groups of infants previously
studied by ourselves.[3-5] His recent study of hyponatraemia and
sensorineural deafness in preterm infants[6] had not been published when our
paper was submitted to the Archives, although we would certainly have
referred to it if it had been.
GEORGE HAYCOCK
References
(1) Haycock GB, Aperia A. Salt and the newborn kidney. Pediatr Nephrol 1991;5:65-70.
(2) Sulyok E, Németh M, Tényi I, Csaba IF, Varga L, Varga F. Relationship between the postnatal development of the renin-angiotensin-aldosterone system and the electrolyte and acid-base status in the sodium chloride supplemented premature infant. Acta Paediatr Acad Sci Hung 1981;22:109-21.
(3) Al-Dahhan J, Haycock GB, Chantler C, Stimmler L. Sodium homeostasis in term and preterm neonates. I. Renal aspects. Arch Dis Child 1983;58:335-42.
(4) Al-Dahhan J, Haycock GB, Chantler C, Stimmler L. Sodium homeostasis in term and preterm neonates.II. Gastrointestinal aspects. Arch Dis Child 1983;58:343-5.
(5) Al-Dahhan J, Haycock GB, Nichol B, Chantler C, Stimmler L. Sodium homeostasis in term and preterm neonates. III. The effect of salt supplementation. Arch Dis Child 1984;59:945-50.
(6) Ertl T, Hadzsiev K, Vincze O, Pytel J, Szabo I, Sulyok E. Hyponatremia and sensorineural hearing loss in preterm infants. Biol Neonate 2001;79:109-12.
In their study on time to positivity of neonatal blood
cultures, Kumar et al[1] conclude that a period of 36 hours is sufficient to
exclude sepsis in otherwise well neonates. They documented that the
negative predictive value of neonatal blood cultures at 36 hours is 98%
for definite or possible pathogenic bacteria. This is also true in our
experience using a different automated blood culture system...
In their study on time to positivity of neonatal blood
cultures, Kumar et al[1] conclude that a period of 36 hours is sufficient to
exclude sepsis in otherwise well neonates. They documented that the
negative predictive value of neonatal blood cultures at 36 hours is 98%
for definite or possible pathogenic bacteria. This is also true in our
experience using a different automated blood culture system to that
employed by Kumar et al[1].
We chose to analyse in detail, neonatal blood culture samples taken
within 48 hours of birth for two reasons. Firstly, neonates with early
suspected sepsis constitute a unique group, as the pathogens are usually
acquired intra-partum. Secondly, the impact on early cessation of
antibiotics and early discharge from the neonatal unit would potentially
be great in this group. We studied a total of 936 neonatal blood cultures
taken from November 1999 to October 2000 of which 189 (20.2%) were
positive. Of the total of 142 neonatal blood cultures taken within 48
hours of birth, the positivity rate was similar (19%). Organisms isolated
were classified as either pathogens or possible contaminants, based on the
identity of the organism, clinico-pathological markers like C-Reactive
Protein (CRP), neutrophil count and clinical picture. 15 of the 27
positive early neonatal blood cultures yielded pathogens. All the
significant cultures became positive within 27 hours of incubation in the
Vital automated blood culture system (bioMerieux, France).
The advent of automated blood culture detection systems allows
significantly earlier detection of most aerobic bloodstream pathogens than
manual systems[2]. Previous data supporting the need for longer
observation times utilized non-automated systems and were reported in an
era when the distribution of pathogenic micro-organisms causing infection
in neonatal units may have been different[3]. Also, as the incidence of
nosocomial neonatal septicaemia varies significantly between units, it is
important to validate locally any changes to current protocols[4]. We
conclude that negative blood cultures at 36 hours can be used to
discontinue antibiotics in cases of suspected early neonatal sepsis. We
encourage others to consider adopting this approach to minimise needless
use of antibiotics with consequent pressure for antimicrobial resistance.
References
(1) Kumar Y, Qunibi M, Neal TJ, Yoxall CW. Time to positivity of
neonatal blood cultures. Arch Dis Child Fetal Neonatal Ed 2001; 85: F182-
6.
(2) Rohner P, Pepey B, Auckenthaler R. Comparison of BacT/Alert with
Signal blood culture system. J Clin Microbiol 1995; 33: 313-7.
(3) Sidebottom DG, Freeman J, Platt R, Epstein MF, Goldmann DA.
Fifteen-year experience with bloodstream isolates of coagulase-negative
staphylococci in neonatal intensive care. J Clin Microbiol 1988; 26: 713-
8.
(4) Brodie SB, Sands KE, Gray JE, Parker RA, Goldmann DA, Davis RB,
Richardson DK. Occurrence of nosocomial bloodstream infections in six
neonatal intensive care units. Pediatr Infect Dis J 2000; 19: 56-65.
Dr da Costa et al, and Dr Gatrad in his accompanying commentary [Arch
Dis Child Fetal Neonatal Ed 2002;86:F115-9], are mistaken in drawing
convulsions about Muslim families in relation to ‘do not resuscitate
orders’. Gatrad suggests doctors should receive training in ethical
issues of other cultures. Firstly, it is impossible to know the religious
or historical or personal background of every parent....
Dr da Costa et al, and Dr Gatrad in his accompanying commentary [Arch
Dis Child Fetal Neonatal Ed 2002;86:F115-9], are mistaken in drawing
convulsions about Muslim families in relation to ‘do not resuscitate
orders’. Gatrad suggests doctors should receive training in ethical
issues of other cultures. Firstly, it is impossible to know the religious
or historical or personal background of every parent. Secondly, Muslims
are not an homogenous group, just as Buddhists or Baptists are not. To
assume that because someone has a particular surname (e.g., Singh, a name
usually associate with Sikhism) or comes from a particular country (e.g.,
India, where many people are Hindus) or is of a particular religion (e.g.,
Catholicism, as there are lapsed Catholics, middle of the road Catholics,
and ardent Catholics) that they have a particular set of beliefs is very
unwise. Indeed, it is racist. For example, I have an evangelical
Christian faith, which is probably different in some respects from many
other evangelical Christians. What would my views be on ‘do not
resuscitate’ if faced with that for my children? Whatever they are, I
would be annoyed if my children’s medical attendants assumed that I had
the same views as all evangelical Christians.
Which raises a third point. Why are such issues only considered for
‘ethnic minority’ groups? I have yet to read a paper or hear a
presentation on cultural aspects for Methodists, Plymouth Brethren, born
again Christians, etc. In the end, though, it doesn’t matter, and neither
do da Costa et al’s or Gatrad’s views. It is important to treat the
families with respect, and listen to them.
I do not know the situation in Oman, where da Costa works, but in the
UK I think the pendulum has swung too far in terms of how we involve
parents in ‘end of life’ decisions. The parents’ views are important but
not determinative. Society, and the Courts, have devolved those decisions
to doctors. To ask parents to be involved in those decisions about their
own children is an unfair burden for them to carry, possibly for the rest
of their lives.
Dear Editor
In a recent issue of the journal, Ng et al. described the endoscopic view of an congenital epiglottic cyst. We report the recently discovered antenatal vallecular cyst (VC). [1] The incidence of VC is low.[2] We discovered this case of congenital VC at 25 weeks of gestation, diagnosed on routine ultrasound survey for polyhydramnios. An axial scan of the oropharyngeal region showed a cystic mas...
Dear Editor
We read with interest the findings of Wolke et al.[1] regarding maternal satisfaction with routine examination of the newborn. Whilst appreciating their conclusions and those reached by others (Lee TWR et al.[2] and Walker D[3])we wish to provide further comment. Perhaps an equally valuable study would be one which explores the attitudes of senior house officers to performing this examinat...
Dear Editor
Armstrong and Simpson’s letter in May’s edition of Archives of Disease in Childhood highlights the difficulties encountered by junior medical staff when examining the neonatal palate.[1] Their concern is echoed by a presentation at the recent Royal College of Paediatrics and Child Health spring meeting. Habel et al. presented the results of their audit revealing that 31 % of isolated cleft pal...
Dear Editor
We read the article by Reece et al [1] and closely followed the responses to it. We even went ahead to carry out a study looking at identification of the tip of the long lines using inversion of image technique on PACS (picture archiving and communication system).
Background: Positioning of long lines into the heart has serious consequences including death due to cardiac tamponade.[2] The...
To The Editor:
I am familiar with the work of Dr Shehadeh et al. There may indeed be a place for insulin in infant formula. However, before such a step is taken, I believe that it is imperative that appropriate prospective studies be done, including safety monitoring. Although our human pilot study and animal studies suggest there may be a benefical effect of oral insulin, much more work needs to be done...
Dear Editor
I read with great interest the article by Shulman.[1] Indeed, orally administered insulin may have a positive effect on gut maturation and mucosal enzyme expression in preterm infants. We have recently demonstrated that human milk is rich in insulin (mean = 60.2 micro U/ml), and that insulin is barely detected in infant formulas.[2] Moreover, we have hypothesized that insulin content of human milk may ha...
I read with interest the report by Al-Dahhan and colleagues on the beneficial effect of NaC1 supplementation of preterm infants during the neonatal period on their later neurodevelopmental outcome. They found better memory, learning, language and educational performances at the age of 10-13 years in prematures who were given 4-5 mMol/day NaC2 when compared to those not receiving NaC1 supplement.[1] In th...
Me thinks Professor Sulyok doth protest too much. His early, pioneering work on electrolyte balance in the newborn is well known (and extensively cited in an earlier review of the subject co-authored by myself.[1] In this, inter alia, his study of the effect of salt supplementation on the renin-angiotensin-aldosterone system [2] is quoted in support of the hypothesis that hyponatraemia in premature infant...
Dear Editor
In their study on time to positivity of neonatal blood cultures, Kumar et al[1] conclude that a period of 36 hours is sufficient to exclude sepsis in otherwise well neonates. They documented that the negative predictive value of neonatal blood cultures at 36 hours is 98% for definite or possible pathogenic bacteria. This is also true in our experience using a different automated blood culture system...
Dear Editor
Dr da Costa et al, and Dr Gatrad in his accompanying commentary [Arch Dis Child Fetal Neonatal Ed 2002;86:F115-9], are mistaken in drawing convulsions about Muslim families in relation to ‘do not resuscitate orders’. Gatrad suggests doctors should receive training in ethical issues of other cultures. Firstly, it is impossible to know the religious or historical or personal background of every parent....
Pages