In a randomised controlled trial 38 asthmatic children aged 2-11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p less than 0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p less than 0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze-free when they left hospital compared with 3 in the placebo group, p less than 0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat 'non steroid dependent' children hospitalised with acute severe asthma.

SUMMARY Total immunoglobulin G (IgG) and subclasses were measured in serum samples from 82 children with chronic asthma, aged 1*5 to 6-3 years, and 76 controls. Concentrations of IgGj, IgG2, IgG3, and total IgG were significantly lower in asthmatic children aged 1 to 5, and IgG2 concentrations were also significantly lower in asthmatic children over 5 years of age. Twenty eight asthmatic children had at least one value in the deficient range, and 26 had IgG2 deficiency alone or in combination. Five children had IgG2 and IgA deficiency. These 28 children were significantly younger and fewer had raised IgE concentrations than the remainder.IgG subclass deficiency, which may reflect delayed maturation of the immune system, is common in young asthmatic children, and may have a role in the pathogenesis of the disease.The importance of respiratory infection in precipitating attacks of asthma is well known. Deficiencies of IgG limited to one or more subclasses have been recognised in children with recurrent infections' and one small study found evidence of IgG subclass deficiency in 'non-allergic children with chronic chest symptoms'.2 Because other forms of immunodeficiency have been associated with atopic diseases, we decided to study IgG subclass concentrations in a large group of chronic asthmatic children. Patients and methodsWe studied 82 children with chronic asthma, all of whom were attending the paediatric respiratory clinic at King's College Hospital. Children were included if they had asthma severe enough to warrant regular bronchodilators or prophylactic medication-that is, at least one severe attack a month, or symptoms on most days. Fifty six boys and 26 girls aged 1-5 to 6-3 years were recruited. The first symptoms of asthma occurred under the age of 1 year in 36, and under the age of 2 in 69. Half the children had symptoms of rhinitis, and half had present or past symptoms of eczema. Skin testing to six common allergens was carried out on 69, and yielded one or more positive reactions in 55. Sixty six had raised serum IgE concentrations (more than two standard deviations above the age matched mean). Forty eight children required steroids by inhalation, five sodium cromoglycate, 10 theophylline, and 19 regular I6 agonists. Serum samples from 76 unselected healthy controls, 38 boys and 38 girls aged 1 to 6-8 years were also analysed. These children were recruited in conjunction with the Michael McGough Foundation; they were in good health at the time of the study and had no history of serious disease.We compared values for male and female controls to determine whether there was any sex difference in IgG subclass concentrations. Because concentrations of IgG subclasses vary with age,3 asthmatic and control children were divided in three groups 1 to 2-99 years, 3 to 4-99 years, 5 to 6-99 years, for the purposes of analysis so that age matched comparison could be carried out. In the 1-2-99 years age group there were 17 controls (eight of whom were boys) and 22 asthmatic children (15 of whom were boys); in th...

In order to determine if umbilical arterial catheter position affects the incidence of necrotizing enterocolitis, clinical outcome was analysed in 308 infants whose umbilical arterial catheter had been randomly allocated to a high (n = 162) or a low (n = 146) position. Necrotizing enterocolitis was classified as suspected or confirmed; all renal, lower limb and local catheter complications were also recorded. High umbilical arterial catheters were in place for longer than low catheters, provided more samples and were removed as an emergency less often. Lower limb blanching and cyanosis were more common with low catheters. Eleven cases of confirmed necrotizing enterocolitis occurred in the "high" group and nine in the "low" group. One case of fatal aortic thrombosis was encountered in the high group. Positioning umbilical arterial catheters in a high position allowed longer functional use and did not increase the incidence of necrotizing enterocolitis.

Measurements of total compliance of the respiratory system by the weighted spirometer technique and of the functional residual capacity by helium gas dilution were attempted in 86 asthmatic children aged 2-2-7-9 years. In all but six of the 86 children reliable measurements could be obtained. Significantly raised functional residual capacity was detected in children with asthma of all degrees of severity. The compliance of the respiratory system was significantly abnormal (reduced) only in children who had symptoms at the time of measurement or who had chronic persistent asthma. The results indicate that these measurements are well tolerated in young asthmatic children. Further work needs to be undertaken to assess the value of this technique in following the response to treatment.

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