A growth chart for premature and other infants. The growth chart covers the period from 28 weeks of fetal life to age 2 years, and allows weight, length, and head circumference to be charted. The time scale is logarithmic, providing the convenience of an extended scale for the earlier months of life, and giving the graphs an approximately linear form. Separate charts for boys and girls are provided, with 10th, 50th, and 90th centiles.Weight charts of individual low birthweight infants illustrate the striking 'catch-up' growth often achieved by these infants.These charts ( Fig. 1 and 2)t have been designed to enable the paediatrician to chart the course of growth in the early months of life as meaningfully as possible. They incorporate two features. Firstly, in order to accommodate those infants born preterm, curves for normal growth in the period 28 to 40 weeks' gestational age are shown as continuous with those for later ages. Secondly, the time scale is logarithmic, so that the scale is extended for the early weeks of life, the period when growth is rapid.The sources of the composite data from which the curves are derived are as follows:(1) Weight and length from birth at 40 weeks' gestation to 2 years, from the British data of Tanner, Whitehouse, and Takaishi (1966).(2) Head circumference from birth at 40 weeks' gestation to 2 years, from the Harvard data published by Nelson (1964).(3) Weight from 32 to 40 weeks' gestation, from the curves given by Tanner and Thomson (1970) for Aberdeen infants. These authors provide separate curves for first-bom and later-born infants, and the data for later-born infants have been used here.(4) Weight at 28 weeks' gestation, from the composite data of Babson (1970). His data combine both sexes and are given in terms of mean and standard deviation (SD). By multiplying the SD by a factor of 1-28, the corresponding 10th and 90th centiles were derived. Curves were then drawn from these points to meet the weight curves at 32 weeks.(5) Length and head circumference from 28 to 40 weeks' gestation, from the data of Babson (1970), which combine both sexes; 10th and 90th centiles were derived as above from the SD values.Despite the variety of sources of the data, no major problems arose in combining them, and the composite curves had only to be slightly smoothed.One convenience of plotting parameters of growth against a logarithmic time scale is that the graphs then tend to become linear, owing to the roughly exponential fall-off of growth rates during the period covered by the charts. With the time scale adopted in the charts, this applies particularly to the graphs for weight and length; the graph for head circumference remains somewhat curved because of the relatively more rapid decline in the rate of growth of the head.It is generally accepted that the fetus gains weight at a slower rate during the last weeks of pregnancy, though the extent of the decline varies in fetal growth curves as constructed by different authors (see Babson, Behrman, and Lessel, 1970). To what extent growt...

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A total of 113 cases of open myelomeningocele operated on shortly after birth were followed up and the 80 survivors (71%) were assessed one and a quarter to seven and a half years later. Their disability was classified in terms of mobility, intelligence, continence, and major complications; these when combined provided an assessment of overall disability. The overall disability of the survivors was minimal in 6%, moderate in 40%, severe in 39%, and very severe in 15%.A number of clinical features present at birth were analysed for their predictive value. Of these the sensory level, which frequently differed from both external and radiological levels of the lesion, correlated with the outcome in terms of mobility, intelligence, continence, major complications, and overall disability; and also with deaths caused by renal failure.A policy of confining operation to those patients with a reasonable chance of achieving independence would involve selecting for treatment a minority of all infants born with open myelomeningocele.

SummaryThe fatty acids in the body fat of 41 British and 37 Dutch infants between birth and 1 year were determined. At birth linoleic acid contributed 1-3% of the total fatty acids of the body fat in infants in both countries. By one month its proportion in the fat of the Dutch infants was about 25% and by four months 32-37%; in the fat of the British infants it was never more than 3%. In the Dutch infants this large increase in the linoleic acid percentage was accompanied by a fall in the percentage contribution of others, particularly the saturated acids myristic, palmitic, and stearic. Infants born preterm showed changes in their fat after birth similar to those in fullterm infants.The difference between the composition of the fat of the infants in the two countries is attributed to the nature of the fat in the milk they received. Until recently most British infants who are not breast-fed have been given milks based on cow's milk with only minor modifications. For the past 10 years many Dutch infants have been given a milk in which all the cow's milk fat has been replaced by maize oil.Dutch infants also had a lower concentration of cholesterol in their serum than British infants, which was not unexpected. The results show that the triglycerides in the adipose tissue are profoundly influenced by the nature of the fat in the diet.

In an earlier paper (Gairdner, Marks and Roscoe, 1952) we drew attention to the fact that the haemoglobin (Hb) level during the first day of life is generally much higher than at birth. We questioned the adequacy of the current explanation, that any rise in the Hb level after birth is the result of transfer of placental blood, and suggested that the effect merited study. We now present further observations comparing the composition of cord blood at birth with venous blood taken from a few minutes to a few hours after birth. Hb, packed cell volume, (PCV), plasma protein and plasma sodium have been measured. From these comparisons we conclude that after birth there is usually a shift of fluid, mainly whole plasma, from the circulation. The volume of the plasma shift may be large, amounting to an appreciable fraction of the initial plasma volume, and the effect may consequently prove to be of some clinical importance. MaterialNinety-two infants were studied, of whom 73 were delivered vaginally and 19 by caesarean section. The mother's permission for blood sampling was obtained. Most of the subjects were normal, but a few of the mothers had toxaemia or diabetes; the results in these were similar to those of the normals and have not been separately analysed. MethodsThe cord was always clamped as soon as conveniently possible, both in vaginal and caesarean deliveries. A blood sample was taken by puncture of the umbilical vein between placenta and clamp. Subsequent specimens were taken from an external jugular, internal jugular or femoral vein, or from the ductus venosus (i.e. the continuation of the umbilical vein). The ductus venosus was used particularly for samples within a few minutes of birth. We have found that the ductus venosus can often be catheterized conveniently by inserting a widebore trocar into the terminal part of the umbilical vein in the cord, and threading a polythene catheter through it.Samples were taken into heparinized tubes. Hb and PCV were estimated as described previously (Marks, Gairdner and Roscoe, 1955), Hb being estimated in duplicate in most cases. Plasma protein was estimated by the biuret method, using 0-2 ml. plasma. Plasma sodium was estimated by flame photometer. These four estimations required about 2 5 ml. of blood. Results(i) Change in Hb Level a Few Hours After Birth. In 92 infants samples were taken one to eight hours after birth and compared with cord blood. These included 19 caesarean deliveries, all but two of which were elective, and thus performed before the onset of labour. Results are shown in Fig. 1. Twenty-two cases showed a negligible change (less than ± 5 %) in Hb level after birth; in two cases there was a fall exceeding 5%, while the remaining 68 (74% of the sample) showed a rise exceeding 5 %. This rise amounted to 6-15% in 24 cases, to 16-25% in 23 cases, and to 26 % or over in 21 cases. In five cases the rise exceeded 40 %, the most extreme example being that of an infant born with an abnormally low haemoglobin level of 10i5 g./100 ml. which six hours after birt...

The cause of the respiratory distress syndrome (RDS) is unknown, hence management of the condition must at present rest on (i) recognition of the physiological disturbances present in the individual case; and (ii) correction of these disturbances, so far as this may be possible, in order that the baby can be given optimal conditions for survival during what is, in a proportion of cases at least, a self-limited illness.The function of the lungs being to take in 02 and to excrete CO2, the course of the respiratory failure seen in infants with RDS can best be followed by observing the changes in the amounts of these gases in arterial blood. A secondary function of the lungs is in the maintenance of normal pH by regulating the amount of carbonic acid in the body. In studying respiratory function in individual cases of RDS we have, therefore, largely depended on serial measurements of four variables-the 02-saturation, Pco2, pH and bicarbonate of arterial blood.Material and Methods The infants studied were those who, because of the presence of respiratory symptoms during the first few hours of life, were considered likely to develop RDS. These symptoms were rapid or laboured breathing, apnoeic spells, indrawing of ribs or sternum, or expiratory moan. A majority of the infants were premature, but some of the most severe cases of RDS were born at term.The infants were nursed in an incubator, the temperature of which was adjusted to maintain the baby's rectal temperature near to 370 C. As it was desired to observe the effect of widely different concentrations of inspired 02, and at times to use high concentrations, it was sometimes convenient to enclose the baby's head in a small 'perspex' hood which easily fitted within the incubator (see Fig. 6). High 02 levels could thereby be maintained with low flow rates of 02 to the hood. This 02 supply could be independently warmed and humidified. Ambient 02 levels were measured with a Beckmann D2 analyser.Arterial samples from an iliac artery were obtained by means of a plastic catheter (O.D. 2 mm.) inserted into an umbilical artery. With experience it was found possible to introduce the catheter in almost every infant, including those of less than 1 kg. After taking a blood sample the catheter was filled with heparin saline (50 units/ml.) which prevented clotting for a period of up to eight hours. The end of the catheter was then closed, and the cord stump and surrounding skin powdered with chlorhexidine and covered with a sterile dressing. The catheter has been left in situ for up to two and a half days. After this time femoral artery puncture has been used when required.Blood samples of about 1-5 ml. were taken under sterile and anaerobic conditions with a syringe, the dead space of which had been filled with heparin saline. A metal washer incorporated in the syringe provided a means of stirring. The syringe was capped and kept on ice until analysis which was done within one hour. 02-content was measured in duplicate or triplicate with the Roughton-Scholander syringe techniqu...

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