Plasma zinc, copper, and selenium concentrations were determined in 129 full-term infants at birth and at the age of four months by electrothermal or hydride generation atomic absorption spectrometry. Of these, 49 infants were exclusively breast-fed (HM), 45 received various commercially available cow's milk formulae (F) and 35 infants were fed partially hydrolysed whey protein formula (PHF). The results were correlated with hematological, biochemical and somatic data. Plasma zinc values decreased from birth to the age of four months in all three groups (p < 0.001). The plasma Zn level of the babies fed PHF were similar to those of breast-fed infants, whereas in F-fed children the zinc values were significantly lower (PHF, 807 +/- 106; HM, 794 +/- 112; F, 725 +/- 111 micrograms l-1; all the measurements were performed at the age of four months). In infants fed PHF formula there was a negative correlation between plasma zinc and weight or height increments. In agreement with the literature, plasma copper and ceruloplasmin increased significantly within the first four months of life. The plasma copper content was similar in either feeding group. Plasma selenium was low at birth (40 +/- 9 micrograms l-1) and remained constant in breast-fed infants. In infants on PHF there was a steeper decline of plasma Se (20 +/- 6 micrograms l-1) than in infants fed cow's milk formula (29 +/- 9 micrograms l-1). Other parameters of the Se status showed a similar pattern. Despite the different zinc, copper, and selenium supply, plus presumedly different bioavailability, all the infants thrived.(ABSTRACT TRUNCATED AT 250 WORDS)

SUMMARY A case of haemolytic uraemic syndrome in a three year old boy is described. The clinical course was complicated by hyperglycaemia, and biochemical assay of plasma showed an almost total lack of pancreatic insulin. Extensive necrosis of the exocrine and endocrine pancreas was found at necropsy. The possible pathological physiology of this complication and its prognostic importance are discussed.The haemolytic uraemic syndrome is a multi-system disease. Small vessel necrosis has been found in most organs, including the islet cells of the pancreas.'-3 Recently, Upadhaya et al described three patients who developed severe hyperglycaemia during haemolytic uraemic syndrome following diazoxide administration.4 We describe a case of haemolytic uraemic syndrome in a patient who did not receive diazoxide but who developed severe hyperglycaemia associated with extensive destruction of pancreatic tissue. Case reportA 3 year old boy was admitted to hospital with an eight day history of diarrhoea and vomiting, with three days of bloody stools, and a five day history of abdominal pain. He had been treated with a standard glucose and electrolyte solution. On admission he was anuric, and prerenal failure was diagnosed.He was treated with volume expansion and, subsequently, antibiotics following bacteriological culture of blood, stool, and urine (all negative). He remained anuric and was transferred to Sheffield Children's Hospital for further management of his renal failure. Examination showed an alert, orientated boy who was mildly oedematous. His blood pressure was 130/90 mm Hg and a grade 1/6 systolic ejection murmur was audible at the left sternal edge. His abdomen was distended but not tender and contained free fluid. No masses were palpable, and the bowel sounds were reduced. Rectal examination was unremarkable. The remainder of the examination was normal.

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and Jhchester. Nineteen exchange-transfusion were performed via he umbilical artery using blood preserved with aciditrate and dextrose in ei ht term /34-40 weeks gest-.tion/ and nine preterm /2%-33 weeks gestation, €350-.560 g body weight/ infants. Plasma lucose rise was mllar in both groups during t r a n s f f m~ 9327; l? 17+7 @I;/. The glucose disappearance vias 1,33+0,20 In eFm and l,4720,19 in prematures. Term infanTs respmded to glucose with a sharp rise in mean plasma in-,ulin /A 24+3 uU/ml/ which was seen three hours folloling the transfusion. /A 4122 uU/rd/. Insulin secret

Twenty exchange transfusions for hyperbilirubinaemia were performed via the umbilical vein or artery in 17 term and pre-term infants. Blood preserved with acid citrate and dextrose was used and the effect of the route of transfusion on plasma glucose, free fatty acid, insulin and growth hormone (GH) concentrations was measured during the transfusion and for 3 h afterwards. Infants transfused via the umbilical vein secreted more insulin than those transfused via the artery although both groups had similar rises in plasma glucose. After transfusion, glucose disappearance was faster and minimum plasma glucose levels were lower in infants transfused via the vein. This group had a smaller fall in plasma free fatty acids during transfusion, but otherwise plasma free fatty acid levels were similar in both groups. More GH was secreted by infants transfused via the artery resulting in higher plasma levels during and after transfusion.