Spilling in infancy is very common, but the majority of children settle by 13 to 14 months of age. However, those with frequent spilling (>90 days) are more likely to have GER symptoms at 9 years of age. In addition, a maternal history of GER was significantly related both to infant spilling and to GER at 9 years, suggesting that a genetic component may be involved. Physicians should consider studying children with a history of frequent infant spilling to determine whether this group is at increased risk for GER disease.

Background -The effect on subsequent respiratory function of spinal stabilisation for scoliosis in Duchenne muscular dystrophy is unclear. In order to clarify this clinical problem, changes in the forced vital capacity of a group of children with Duchenne muscular dystrophy who had undergone spinal surgery were measured and compared with a group of children with Duchenne muscular dystrophy who had not had surgery. Methods -In this retrospective study 17 boys with Duchenne muscular dystrophy who underwent spinal stabilisation at a mean age of 14-9 years (surgical group) were compared with 21 boys with Duchenne muscular dystrophy who had not had surgery (non-surgical group). The mean (SD) Cobb angle of the surgical group at 14-9 years was 57 (16.4)0, and of the non-surgical group at 15 years was 45 (29.9)°. Forced vital capacity expressed as percentage predicted (% FVC) was measured in total over a seven year period in the surgical group and over 6 5 years in the non-surgical group, and regression equations were calculated. Survival curves for both groups were also constructed. Results -No difference was found between spinal stabilisation (surgical group) and the non-surgical group in the rate of deterioration of % FVC which was 3-5% per year. There was no difference in survival in either group. Conclusions -Spinal stabilisation in Duchenne muscular dystrophy does not alter the decline in pulmonary function, nor does it improve survival.

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Since the 1960s there has been a continual improvement in the survival of premature infants of birthweight less than 1500 g. This has resulted in an increase in the prevalence of bronchopulmonary dysplasia (BPD), or its milder form, chronic lung disease (CLD) of prematurity. In children with BPD; the initial air trapping improves in the first 3-4 years of life, but small airway obstruction is often slow to improve, suggesting dysanaptic lung growth. Despite this, the majority of older children and adolescents with BPD/CLD do not have significant respiratory symptoms. Children born prematurely with or without hyaline membrane disease may also have a reduction in expiratory flows during childhood, albeit less severe. The clinical significance of this in the longer term is unclear. Although significant associations between decrements in expiratory flows, neonatal oxygen therapy and assisted ventilation have been demonstrated. Airway function has also been reported to be largely unrelated with perinatal events but strongly associated with birthweight. The latter suggests that intra-uterine factors such as under-nutrition may be more important than hitherto recognized. Because of a lack of longitudinal studies, it is unclear how lung function will track during adolescence and adult life. Bronchial hyper-responsiveness is significantly increased in children with BPD and to a lesser extent in those born prematurely with or without hyaline membrane disease. It is unclear whether this is due to a genetic predisposition, neonatal lung injury or anatomically smaller airways. Given the morbidity and fiscal cost of a premature birth, effective strategies to reduce the premature birth rate are needed.