The changing concepts of paediatric care

An inaugural lecture on the evolving science of pediatric health carer, given in the University of Rhodesia on the 20th July, 197

Leucocyte Function in Protein Deficiency States

Seventy-five patients, comprising 3 groups of 25 normal infants (group I), 25 infants suffering from protein energy malnutrition (PEM-kwashiorkor) (group 11) and 25 infants with PEM plus infection (group Ill) were .axamined, with particular reference to their total leucocyte count and the response of their white cells to incubation with nitroblue tetrazolium (NBT), with and without latex particle stimulation. No difference in leucocyte counts could be demonstrated between the groups; however, both groups of malnourished patients (groups ll and lll) had elevated NBT levels, although no difference could be detected between those malnourished infants with and without clinical or laboratory evidence of infection, or both. The data indicate that although primarily protein-deficient malnourished patients have a quantitative deficiency in leucocyte response, qualitative leucocyte function may be normal. S. Afr. Med. J., 48, 528 (1974

Another Look at Cord Blood Proteins - Changes with the birth weight and as a predictor of Hyaline membrane disease in neonates

The total cord protein (TCP) and albumin levels of 287 Black babies (155 term and 132 low birthweight) were measured, related to birthweight, and compared with international figures, in order to clarify previously published inconclusive data. An assessment was also made as to whether a previously published level of 4,6 g/100 ml TCP or less, proved of good predictive value to the development of hyaline membrane disease (HMD) in Black babies. TCP levels, as measured by a chemical and meter method, were noted, and the accuracy of the methods compared and statistically evaluated

Leucocyte function in protein deficiency

Seventy-five patients, comprising 3 groups of 25 normal infants (group I), 25 infants suffering from protein energy malnutrition (PEM-kwashiorkor) (group 11) and 25 infants with PEM plus infection (group Ill) were .axamined, with particular reference to their total leucocyte count and the response of their white cells to incubation with nitroblue tetrazolium (NBT), with and without latex particle stimulation. No difference in leucocyte counts could be demonstrated between the groups; however, both groups of malnourished patients (groups 11 and III) had elevated NBT levels, although no difference could be detected between those malnourished infants with and without clinical or laboratory evidence of infection, or both. The data indicate that although primarily protein-deficient malnourished patients have a quantitative deficiency in leucocyte response, qualitative leucocyte function may be normal.S. Afr. Med. J., 48, 528 (1974)

The Vitalograph - A Study of Its Role in Pulmonary Function Testing in Childhood

A dry spirometer (Vitalographt) has been examined in relation to its mechanical reproducibility, and feasibility for use in paediatric pulmonary function testing. Measurementsat ATPS and BTPS indicate a -2'10% to + 13'47% variability in volume readings respectively. Measurements on 304 normal healthy children, aged 6 -18 years, height 120 - 174 cm were made using this dry spirometer and statistically compared with normal available water spirometric data. Except for mid-expiratory flow rates, all compare favourably

Reliability of an icterometer in black neonates with hyperbilirubinaemia

A perspex icterometer previously graded for White neonates was evaluated in an unselected Black newborn population. Grades of icterus showed a close correlation with levels of total serum bilirubin (TSB) as determined colorimetrically in a bilirubinometer. Previously reported data on White babies follow the same pattern, but are slightly higher for each grade.S. Afr. Med. J., 48, 1533 (1974)

Hazards of handling

A study of the bacterial flora among infants, mothers, staff (nursing and medical), and the environment of a neonatal unit is outlined. On admission to the unit, 60,5% of babies were already infected, presumably from contact with medical staff. By day 15 this number had increased significantly. A large number of mothers (40% on day 1, and 91% on day 15) were found to be carrying pathogenic organisms, providing a significant bacterial reservoir in the unit. Few pathogens were isolated from the environment.S. Afr. Med. J., 48, 1165 (1974)

Blood Xylose Concentrations in Protein Energy Malnutrition

One-hour blood xylose concentrations have been advocated as screening tests for coeliac disease in childhood. It was therefore postulated that this test might be useful as a diagnostic index of the degree of malabsorption associated with protein energy malnutrition (PEM) and that it might indicate the type and severity of the nutritional abnormality. In addition, it was hypothesised that this test might be useful to document response to therapy. Seventy-six children with PEM were divided into 3 groups (marasmic (M), marasmic kwashiorkor (MK) and kwashiorkor (K» and I-hour blood xylose concentrations and serum albumin levels were estimated on admission, and in 45 and 43 patients respectively, on day 7 and on clinical recovery. Blood xylose levels were correlated with type of PEM, severity of oedema, serum albumin levels and response to treatment. An assessment was also made to elucidate whether gastro-intestinal infection influenced blood xylose concentrations. In addition, 22 patients (3 M, 9 MK and 10 K) had jejunal biopsies within 3 days of admission, with repeat biopsies in 13 (2 M, 5 MK and 6 K) before discharge from hospital. Results show, on admission, a significant difference in blood xylose and albumin levels between the marasmic and the two oedematous groups (MK and K), no significant difference existing between blood xylose levels in the 3 study groups by day 7, or on recovery. Gastro-intestinal infection did not alter this. Serum albumin levels were highest in the M group, on admission and throughout the study. Decreased xylose and albumin concentrations were associated with gross oedema. Further, no correlation was found between blood xylose and serum albumin levels in any group, nor between blood xylose concentrations and jejunal histology grade. It is suggested that low blood xylose concentrations in PEM are the result of dilution rather than malabsorption. The test does not indicate the degree of small-bowel atrophy, nor does it provide significant additional information to the clinical appraisal

Is a Priming Dose of Insulin Necessary in a Low-Dose Insulin Protocol for the Treatment of Diabetic Ketoacidosis?

OBJECTIVE—The purpose of this study was to assess the efficacy of an insulin priming dose with a continuous insulin infusion versus two continuous infusions without a priming dose