William C. MacLean

A comparison of ipecac syrup and apomorphine in the immediate treatment of ingestion of poisons

The safety and effectiveness of apomorphine and ipecac syrup were compared on arandomized basis in the treatment of acute poisoning by ingestion in 86 children. Onset of vomiting was more rapid with apomorphine than with ipecac. Children in the apomorphine group vomited a greater number of times. There was significantly more central nervous system depression with apomorphine. Both drugs had similar failure rates. The time gained by the use of apomorphine is probably not clinically significant, and the central nervous system depression caused by the drug constitutes the major drawback to its routine use.

Scalp abscess secondary to fetal scalp electrode

The n u m b e r of infants moni tored by spiral scalp electrode was est imated to be a m a x i m u m of 1,030 (50%) of the 2,061 live births. Of these, at least n ine subsequent ly developed a scalp abscess, an incidence of 0.9%. In six of n ine infants, cultures of the abscess were positive: five with a single organism (three with Hemophilus influenzae type b, one with B-hemolytic streptococcus group A, one with microaerophi l ic streptococcus), and one with three organisms (B-hemolytic streptococcus group B and two anaerobes) . In two infants an identical organism was cul tured f rom blood and abscess: Hemophilus influenzae type b in one infant who, t reated with ampici l l in in t ravenously for 14 days, m a d e an uneven t fu l recovery, and B-hemolytic streptococcus group A in a second infant whose case history follows.

Transient steatorrhea following episodes of mild diarrhea in early infancy.

Fecal fat excretion was studied after a mild episode of diarrhea in eight infants for whom adequate control data were available. Mean age of onset of diarrhea was 28 days. Duration of the episode, defined as the number of days until the infant was again feeding and libitum, averaged 5.1 days. Balance studies were carried out 3 to 13 days later. Mean fecal fat excretion rose from a prediarrhea value of 2.9 +/- 1.4 gm/day to 8.7 +/- 3.1 gm/day following diarrhea (P less than 0.001). Restudy of five infants one month later showed persistent steatorrhea in one. Mild transient steatorrhea may follow mild diarrhea in infancy and should be considered in infants who are slow to gain weight subsequent to an episode of diarrhea.

Oral iron absorption in infantile protein-energy malnutrition

The ability of infants with protein-energy malnutrition to absorb iron was assessed using the serum iron response to a dose of ferrous sulfate providing 3 mg elemental iron per kg body weight. Responses were grouped as flat (delta serum Fe less than 30 microgram/dl), intermediate (30 to 100 microgram/dl), and normal (greater the 100 microgram/dl). Of 25 consecutively admitted children studied, seven had a flat, five an intermediate, and 13 a normal curve (mean delta serum Fe: 10 microgram/dl, 66 microgram/dl, and 175 microgram/dl, respectively). There were no differences among the three groups in hematocrit, fasting serum iron or transferrin saturation, severity of malnutrition, or evidence of other malabsorption sufficient to explain these differences. Although hematocrits, fasting serum iron, and transferrin saturations did not change appreciably during nutritional rehabilitation, all children with initially abnormal responses subsequently had normal tests.

The nutritional value of oat flour for very young children.

Whole groat flour was consumed by nine infants and young children as 22.5, 45, or 67% of total diet energy (one half of 6.4%, all of 6.4%, or all of 9.6% protein energy). Isonitrogenous and isoenergetic casein control diets were given. Apparent absorption of oat nitrogen (N) was consistently around 75% of intake (casein, 87%), but absorptions of oat energy, carbohydrate, and fat, as percentages of intake, decreased disproportionately as oat flour intake was doubled and then tripled. Apparent retentions were 39 ± 5% of mixed oat-casein protein intake in the 22.5% diet, the preceding and following casein controls being 38 ± 8% (NS) and 44.4% (p<0.05) of the intakes; 32 ± 6% from oats in the 45% diet, controls 38 ± 5 and 46 ± 5% (both p<0.05), and 33 ± 11% from oats in the 67% diet, controls, 36 ± 9% (NS). Fasting plasma free total essential amino acid (TEAA) levels of children consuming 45% oats were low (562 ± 119 μmol of TEAA/L) and did not change significantly after meals. Fasting molar proportions of individual essentials (millimoles of EAA per mole of TEAA) were similar to those from milk protein diets and did not vary significantly 3 and 4 h after feeding, suggesting that no individual amino acid, but rather protein digestibility, was first limiting to N retention. Oats are a satisfactory source of energy, protein, and fat for very young children and many infants.