SummaryIsotonic saline is a widely-used infusion fluid, although the associated chloride load may cause metabolic acidosis and impair kidney function in young, healthy volunteers. We wished to examine whether these effects also occurred in the elderly, and conducted a crossover study in 13 men with a mean age of 73 years (range 66-84), who each received intravenous infusions of 1.5 l of Ringer's acetate and of isotonic saline. Isotonic saline induced mild changes in plasma sodium (mean +1.5 mmol.l À1 ), plasma chloride (+3 mmol.l À1 ) and standard bicarbonate (À2 mmol.l À1 ). Three hours after starting the infusions, 68% of the Ringer's acetate and 30% of the infused saline had been excreted (p < 0.01). The glomerular filtration rate increased in response to both fluids, but more after the Ringer's acetate (p < 0.03). Pre-infusion fluid retention, as evidenced by high urinary osmolality (> 700 mOsmol.kg À1 ) and/or creatinine (> 7 mmol.l À1 ), was a strong factor governing the responses to both fluid loads.

<b><i>Introduction:</i></b> Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal. <b><i>Objective:</i></b> The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years. <b><i>Methods:</i></b> In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score &#x3e;1 standard deviation below the mean was defined as “at risk” for developmental impairment. <b><i>Results:</i></b> At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were “at risk” for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), <i>p</i> = 0.02. <b><i>Conclusion:</i></b> There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were “at risk” for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age.

Aim It has been suggested that intact cord resuscitation can reduce the risk of brain damage. We investigated the effects on neurodevelopment at two years of age. Methods This study was performed in Kathmandu, Nepal. In 2016, 231 late preterm and term infants born vaginally and not breathing were randomised to resuscitation with an intact cord or the standard practice of early cord clamping (CC). At two years of age, the World Health Organization's Infant and Young Child Development tool was used to assess the child's neurodevelopment, during telephone interviews with caregivers. Results We followed up 138 infants (59.7%) at a mean age of 24.8 ± 0.8 months. A significant difference was seen in the development for age Z‐score, between the group resuscitated with an intact umbilical cord and the group resuscitated with early CC. The median (range) scores were 1.0 (0.1‐2.1) vs 0.9 (−2.0 to 1.8), respectively (P = .04). There was no difference in the motor, language‐cognitive and socio‐emotional domains. Conclusion Neurodevelopment improvements were observed at two years of age in infants resuscitated with an intact rather than early clamped umbilical cord. No definitive conclusions could be drawn due to protocol violations and a low follow‐up rate. More research is needed.

954. Use of 5-fluorocytosine in systemic candidiasis in infancy. Three cases of systemic candidiasis were successfully treated with 5-fluorocytosine (5-FC), an antifungal agent. The fungaemia developed during continuous intravenous alimentation for intestinal malabsorption. The diagnosis was confirmed by repeated positive cultures from blood, urine, and faeces. The fungus was also grown from cultures of intravenous solutions and catheters. The clinical features varied and included unexplained fever, oedema, stupor, tachypnoea, convulsions, hepatosplenomegaly, and congestive heart failure. The clinical symptoms receded rapidly and the cultures became negative after oral or intravenous treatment with 5-FC.