Sir,Your correspondent, M. D. Armstrong (Archives, 1975, 50, 830), asks the right question, namely, 'Are children born of histidinaemic mothers at risk of harm during gestation ?'. but does not provide anything other than anecdotal evidence in his attempt to answer it. The children of our 37-year-old woman with histidinaemia were exactly like his, i.e. 'None had shown any signs of slow or abnormal development during infancy or childhood, . :. We suspected nothing but did get full-scale IQ measurements done on both parents and the 4 older children.As reported in our paper (Lyon, Gardner, and Veale, 1974) Administration of parenteral iron to newborn infants Sir, Scott et al. (1975) suggest that the possibility of reducing the anti-infective role of unsaturated transferrin may caution the use of iron by the parenteral route in newbom infants. Our clinical and laboratory experiences support their suggestion. A policy of giving infants considered to be at risk of iron deficiency anaemia 2 ml of iron dextran complex intramuscularly during the first week of life was adopted at the National Women's Hospital, Auckland, in 1970. At the same time a similar prophylactic treatment of low birthweight infants was advanced from later than the first month of life to as early as the first week. There are about 5000 deliveries annually at the hospital and before 1970 there had been an average of 1-2 cases of Esch. coli meningitis annually. In 1971 and 1972 there was a total of 21 cases of Esch. coli meningitis, 18 of which arose within 2-5 days of the administration of iron dextran (Farmer, 1973). The incidence of Esch. coli meningitis returned to the previous level when the treatment of term infants was made more selective and treatment of low birthweight infants was either discontinued or given only after 1 month of age. A similar experience with Esch. coli meningitis and septicaemia caused Barry and Reeve (1973) to abandon another programme of prophylactic administration of iron to newborn Polynesian infants.We have studied blood taken from infants before and 24 hours after administration of iron dextran, and have confirmed a diminished bacteriostatic activity against Esch. coli accompanying very high iron levels in the post-treatment serum (Becroft, Dix, and Farmer, unpublished observations, 1976 It seems that parenteral iron should be used only when it is essential and always with caution, particularly in children with low plasma concentrations of transferrin, such as the newbom, the malnourished, and certain protein losing states.We wonder about the effect of oral iron which we give to preterm babies. Few such babies, however, achieve a high saturation of transferrin with iron (Brozovic et al., 1974).
