H. de V. Heese

Prevalence of asthma: a comparative study of urban and rural Xhosa children.

An epidemiological study was undertaken to determine the prevalence of asthma in young urban and rural black (Xhosa) children. One thousand three hundred and seventy five children were studied, 694 from a Cape Town african township and 671 from a rural area in Transkei. The exercise tolerance test which required free range running at maximum effort for 6 min was used to identify asthmatic subjects. A fall of 15% or more in the post‐exercise FEV1 and PEFR values was regarded as a positive result. Twenty‐three children were found to be asthmatic, twenty‐two from the city area, but only one from the country, giving a prevalence figure for asthma of 3.17% in the first group and 0.14% for the second. Possible reasons for these differences are discussed.

An epidemiological study of well-water nitrates in a group of south west african/namibian infants

Abstract A study of 486 infants consuming well-water with various nitrate concentrations showed a strong correlation between actual nitrate intake and methaemoglobin levels. The regular administration of Vitamin C to infants is more important than the effects of age in lowering methaemoglobin levels. Mothers who live in high nitrate-bearing areas have increased infant wastage.

The management of polycythaemia in the newborn infant

Abstract The management of polycythaemia with hyperviscosity in newborn babies who are clinically well, or who only have minor signs, is not clear. Forty-nine such babies were randomly divided so that 24 were given a partial plasma exchange transfustion and the others were left hyperviscous. The babies were compared with normal controls. Clinical signs were more frequent in exchanged babies, and one developed necrotizing entercolitis. Of the hyperviscous babies 41% had plethoric lungs, 12% abnormal electrocardiograms, 9% were hypocalcaemic and 30% hypomagnesaemic. Behavioural testing after birth revealed differences in both groups when compared with controls. There were more poor scores in the exchange transfusion group. Neurological examination did not reveal marked differences among the groups. Developmental and neurological achievement at 8 mth of age was normal in all the babies. In the present study it is suggested that newborn babies with hyperviscosity who are clinically well or who only have minor signs do not necessarily benefit from partial plasma exchange transfusion.The management of polycythaemia with hyperviscosity in newborn babies who are clinically well, or who only have minor signs, is not clear. Forty-nine such babies were randomly divided so that 24 were given a partial plasma exchange transfusion and the others were left hyperviscous. The babies were compared with normal controls. Clinical signs were more frequent in exchanged babies, and one developed necrotizing entercolitis. Of the hyperviscous babies 41% had plethoric lungs, 12% abnormal electrocardiograms, 9% were hypocalcaemic and 30% hypomagnesaemic. Behavioural testing after birth revealed differences in both groups when compared with controls. There were more poor scores in the exchange transfusion group. Neurological examination did not reveal marked differences among the groups. Developmental and neurological achievement at 8 mth of age was normal in all babies. In the present study it is suggested that newborn babies with hyperviscosity who are clinically well or who only have minor signs do not necessarily benefit from partial plasma exchange transfusion.

Patterns of retarded fetal growth.

The measurement of weight, length and head circumference at birth was used to document the size and shape of infants born at term in a population where mothers are relatively short and underweight. Different patterns of intrauterine growth are proposed to explain the variation in the infants appearance at birth. Most of the small-for-gestational-age infants were proportionately stunted. This pattern of fetal growth is probably characteristic of infants born to undernourished mothers in economically developing communities, and reflects prolonged intrauterine growth retardation.

IRON FORTIFICATION OF INFANT MILK FORMULA : THE EFFECT ON IRON STATUS AND IMMUNE FUNCTION

We conducted a randomized double-blind trial of a cows milk infant formula with increased iron fortification in order to confirm its safety and to measure its effects on iron status and immune function. A group of full-term, well nourished and healthy infants was followed from the age of 3 months to 1 year. A control group of 74 infants was given a commercially available infant formula containing 8.3 mg Fe/100g. The test group of 75 infants received a similar formula with 40 mg Fe/100 g. The formula with the extra iron proved to be safe and, when compared with the control group, the children in the test group had significantly improved iron status as reflected by the proportion of children classed as normal (25 of 61 cf. 44 of 65; p less than 0.003), and by the mean values of the haemoglobin concentration (11.5 cf. 11.9 g/dl; p = 0.04), red cell distribution width (15.5% cf. 14.4%; p = 0.0005), red cell zinc protoporphyrin (3.4 cf. 4.0 micrograms/g Hb; p = 0.04) and ferritin (29 cf. 17.3 micrograms/l; p = 0.004). The extra iron fortification depressed zinc concentration in plasma (90.6 cf. 83.5 micrograms/l; p = 0.05). There was no significant difference between the two groups for laboratory measures of immune function or for incidence of infection. No adverse effects such as infection could be attributed to the increased iron. We conclude that iron fortification of cows milk infant formula may be safely increased to 40 mg/100 g (i.e. by a factor of 4.8 over the common concentration of 8.3 mg/100 g), but that this has less than the expected effect on iron status. Further studies are required to define (a) the long-term role of facilitators of iron absorption such as ascorbic acid, (b) the interaction of iron with absorption of divalent trace elements such as zinc, and (c) the effect of iron status on immune function and susceptibility to infection.

Spontaneous Pneumothorax in the Newborn

The obstetrical, clinical, radiological and biochemical findings in 7 cases of spontaneous pneumothorax of the newborn are presented. All the infants survived. Attention i s drawn to the presence of a chest bulge as a prominent physical sign in the diagnosis of pneumothorax. The significance of irritability in association with a rapid respiratory rate is discussed.

Group B meningococcal infection in children during an epidemic in Cape Town, South Africa.

One hundred and thirteen children with meningococcal infection were studied during an epidemic caused by N. meningitidis group B. Fifteen per cent presented with only meningeal symptoms, the remainder showed signs of septicaemia or combined septicaemia and meningitis. Sixteen per cent of the children were in shock and 18% required admission to the Intensive Care Unit (ICU). The mortality was 4.4%. More than half the children were younger than 2 years old. There was no statistical association between the age or nutritional state of the children and any of our measures of severity. A short history of symptoms was more common in children who presented with septicaemia and severe illness, who needed admission to the ICU, or who died. Diagnosis was confirmed by routine bacteriological methods and counter-immuno-electrophoresis (CIE) in 104 children. Eighty-six per cent of the isolates were group B type 2. A history of recent antibiotic treatment was associated with fewer positive cultures, but detection of meningococcal antigen by CIE was not affected by this. CIE antigen detection was not reliable because of the high incidence of false-negative results.

Placental size of small-for-gestational-age infants at term

Placental size was compared between appropriate-for-gestational age (AGA) and small-for gestational age (SGA) infants born at term. Placental weight, chorionic plate area and villous surface area were significantly reduced in the SGA infants. Although the ratio of placental weight to birth was similar in the AGA and SGA infants, the latter had significantly underweight placentas for their head circumference and crown-heel length. The ratios of placental weight to assessed brain weight and villous surface area to assessed brain weight were also significantly reduced in the SGA infants. It is concluded that the study SGA infants had both absolutely and relatively small placentas.

Cord blood and maternal total eosinophil counts in relation to infant allergy

The predictive value of raised cord blood (CB) total eosinophil counts (TEC) with regard to atopic sensitisation was studied prospectively for 1 year in 53 Black, 52 White and 57 Mixed full‐term newborns. The maternal TEC, in relation to the stress of labour, were also studied. Ethnic differences in the CB TEC were shown between the Black/White (p = 0.03) and the White/Mixed (p = 0.05) groups. The newborns sex, anatopic family history (aFH) and the method of birth had no influence on the CB TEC in any ethnic group. There were no unequivocal differences in CB TEC between those newborns who became atopic during infancy and those who did not in any of the ethnic groups, although in the Black infants, there was a marginal trend towards significance (p = 0.05). Raised CB TEC values do not, therefore, seem to be an inherited factor in terms of a predisposition for atopic disease.

Serum zinc and copper levels in children with meningococcal disease

Mean serum zinc and copper levels were depressed in 94 children aged 1 month to 9 years who presented with meningococcal disease. The mean serum zinc level was 44 μg/dl (reference value 78 μg/dl, SD 18) and the mean serum copper level 157 μg/dl (reference value 159 μg/dl, SD 27). Nineteen patients had serum zinc levels less than 25 μg/dl and ten patients had serum copper levels less than 101 μg/dl.Serum zinc levels were significantly lower in patients who were septicaemic or in whom manifestations of severe disease such as shock, more than 20 petechiae, ecchymoses and evidence of disseminated intravascular coagulation occurred compared to those without these features.Serum copper concentrations were higher than reference levels in patients with meningitis and in less severely ill patients. Copper levels were significantly lower in patients with septicaemia, severe disease, shock, more than 20 petechiae, ecchymoses, disseminated intravascular coagulation, leucopenia and patients who died compared with patients without these features.