Phylloquinone (2-methyl-3-phytyl-1,4-naphthoquinone) in human and cows' milk and in infant formula foods has been assayed by a method based on high-performance liquid chromatography (HPLC). The method has three chromatographic steps consisting of a preliminary purification of lipid extracts by conventional liquid chromatography, a further fractionation by semipreparative HPLC and a final analytical step by reversed-phase HPLC in which phylloquinone was resolved from the remaining contaminants and quantified by reference to an internal standard (phylloquinone 2,3-epoxide). The identity of the chromatographic peak ascribed to phylloquinone (vitamin K1) was established by mass spectrometry. Mature human milk from 20 lactating mothers gave a mean concentration of phylloquinone of 2.1 micrograms/liter, and colostrum from 9 mothers gave a mean value of 2.3 micrograms/liter. These levels in human milk were significantly lower than those found in either Friesian (holstein) cows' milk (mean 4.9 micrograms/liter) or unsupplemented infant formula foods containing only cows' milk fat (mean 4.2 micrograms/liter). The mean phylloquinone content of two unsupplemented infant formula foods containing only vegetable oils was 11.5 micrograms/liter. After an oral dose of 20 mg phylloquinone, the concentration of K1 in the breast milk of one mother rose to 140 micrograms/liter after 12 hours and at 48 hours was still about twice the average endogenous level of human milk.

From a cohort of 10 686 live births, 322 (3%) were identified as being at risk of a hearing impairment defined as moderate, or worse. These neonates were screened by measurement of auditory brainstem responses. The neonatal at risk screening programme was effective in terms of both yield and cost. The mean age at which hearing aids were fitted was 6 months in the children identified by the neonatal screen. Such a programme is both practicable and useful in a district general hospital. The yield from the neonatal programme was, however, only 43% of the total number of deaf children eventualiy identified from the cohort. The need to identify more deaf children by a sensitive infant distraction test screening programme remains.

Eighty-two Asian women (mostly Muslims) living in East London were prospectively studied through their pregnancy and delivery. Their infants were assessed during the second year of life for growth, nutrition, morbidity, development and vaccination history. There was no increase in perinatal or infant mortality over the general population in the same borough, though there was increased infant morbidity, most commonly iron deficiency (in 25%), and one child with subclinical rickets. One child had a genetic neurodegenerative disorder. The incidence of low birth weight babies was only slightly greater than that of the district as a whole, but after 1 year of age they were less well grown than the population studied by Tanner & Whitehouse. Sixty-four per cent of the women started to breast feed, but many also gave artificial milk and they usually ceased to breast feed earlier than most women in the same district. When half of the women were randomly allocated to receive specialized education, with the others acting as controls, very few attended and little benefit was detected. Though the significance is doubtful, the infants of those educated did tend to be better grown (especially in length), be less likely to have development well below average, have reduced morbidity and have more complete immunization schedules than those of the women not receiving education. This study shows no benefit due to antenatal education, but suggests that the children have advantages when their mothers have the drive to attend the education sessions.

SUMMARY Two neonates with arrhythmias and the long QT syndrome are described. The arrhythmias were detected in utero and both infants were apparently well after birth. The first infant, although well, had a bradycardia for the first 9 days of life. A normal heart rate was documented at 10 days but a prolonged QT interval was not appreciated on the ECG. He was discharged from hospital but died suddenly and unexpectedly 3 days later. A post-mortem examination failed to find a cause for his death which therefore fell into the category of the sudden infant death syndrome (SIDS). A retrospective analysis of the perinatal electrocardiogram showed a probable junctional rhythm with 2:1 conduction to the ventricle; the QT interval was prolonged at 0 * 52 seconds (QTC = 063). The second infant had a QT interval of 0 * 52 seconds (QTC 0* 54) and frequent ventricular premature beats on a 24-hour electrocardiogram. She was treated with propranolol and remains well 2 years later. Sudden infant death has often been described in the siblings of children with the long QT syndrome and one other report described a case of SIDS which was said to have had a prolonged QT interval on the perinatal ECG. This report, however, provides unquestionable evidence, in one case, of an association between the long QT syndrome and SIDS.

Summary In a double‐blind controlled crossover trial of inhaled disodium cromoglycate and beclomethasone dipropionate in juvenile asthma, beclomethasone produced higher therapeutic scores but significantly so in only two indices–wheeze‐free days and morning peak flow rates. Combined treatment offered no advantage over beclomethasone alone. No side‐effects were noted. The findings confirm other studies of cromoglycate and a steroid aerosol (betamethasone 17‐valerate) but disagree with the only other comparative trial of cromoglycate and beclomethasone, in which both were found equally effective.