JohnO. Forfar

Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants.

Pregnant women receiving daily supplements of 400 IU (10 microgram) of vitamin D2 from the 12th week of pregnancy had plasma calcium concentrations higher at 24 weeks but similar at delivery to those in control pregnant women who did not receive the supplements. Infants of the women receiving the supplements had higher calcium, lower phosphorus, and similar magnesium concentrations on the sixth day of life and a lower incidence of hypocalcaemia than infants of the control women. Plasma concentrations of 25-hydroxycholecalciferol, which showed a seasonal variation, were higher in mothers and infants in the treated group. Cord-blood calcium, magnesium, phosphorus, and 25-hydroxycholecalciferol concentrations correlated with maternal values at delivery. Breast-fed infants had higher calcium and magnesium and lower phosphorus and 25-hydroxycholecalciferol concentrations than artificially fed infants. A defect of dental enamel was found in a high proportion of infants (many of whom had suffered from hypocalcaemia) born to the control women. These results suggest that vitamin D supplementation during pregnancy would be beneficial for mothers, whose intake from diet and skin synthesis is appreciably less than 500 IU of vitamin D daily.

ENAMEL HYPOPLASIA OF THE TEETH ASSOCIATED WITH NEONATAL TETANY: A MANIFESTATION OF MATERNAL VITAMIN-D DEFICIENCY

Abstract Of 112 infants with neonatal tetany 63 (56%) later showed severe enamel hypoplasia of the deciduous teeth. Histological examination of affected teeth shows a prolonged disturbance of enamel formation in the three months prior to birth. An inverse relationship is demonstrated between the mean daily hours of bright sunshine in each calendar month and the incidence of neonatal tetany three months later. This suggests that the enamel hypoplasia (and the neonatal tetany) is a manifestation of deficiency of vitamin D during pregnancy, and is most likely due to the secondary hyperparathyroidism which results in the mother.

ANTENATAL FACTORS ASSOCIATED WITH NEONATAL HYPOCALCÆMIC CONVULSIONS

Abstract 74 infants in whom neonatal hypocalcaemic convulsions developed were compared with a control group of infants born in the same hospital. There was a preponderance of males among those infants with convulsions and a high proportion were born in the late winter or early spring. The mothers of the infants with convulsions were significantly older, of higher parity, and of lower social class than the controls.

HYALINE-MEMBRANE DISEASE, ALKALINE BUFFER TREATMENT, AND CEREBRAL INTRAVENTRICULAR HÆMORRHAGE

Abstract In 55 preterm infants dying from hyaline-membrane disease (H.M.D.) in 1971-74, infants with associated cerebral intraventricular haemorrhage (H.M.D./I.V.H.) had been given more intravascular sodium-bicarbonate solution, but the same proportions of cases with H.M.D. and H.M.D./I.V.H. received bicarbonate at the time of birth. Much of the sodium-bicarbonate solution given to H.M.D./I.V.H. infants was injected in response to the clinical effects of I.V.H. Maximum serum-sodium concentrations correlated with sodium-bicarbonate dosage but not I.V.H. The incidence of I.V.H. in preterm infants in 1971-74 was unchanged from 1956-59 when alkaline buffer treatment was not used. These findings do not suggest that sodium-bicarbonate therapy plays a major part in the pathogenesis of I.V.H.

THE ROLE OF THE PÆDIATRICIAN IN ADOPTION MEDICAL PRACTICE

Abstract At present less than 10% of adoption medical examinations of infants are carried out by paediatricians. The preponderance of examinations by doctors less experienced in child health may result in unnecessary rejections, following unsuitable insurance-type examinations, particularly in view of the concept that unadoptibility is never absolute. It is the 10-20% of potentially adoptable infants with defects in their constitution or family history who demand the highest professional paediatric judgment, in consultation with the prospective adopters, and, if necessary, with geneticists or psychiatrists. Paediatricians can also help by providing training in paediatrics, including developmental paediatrics, for those without this knowledge who propose to undertake adoption examinations; by replacing the concept of an insurance-type examination with that of a full paediatric and social assessment; and by advising adopters on the medical needs of the child whom they propose to adopt.