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With a view to combating the long-term effects of iron deficiency anemia in infants, we carried out a screening program of infants at nine months of age in the Well Baby Clinic. We screened 4751 infants using complete venous blood count analysis; 2668 were anemic (Hb <11 gm/dL). Those with hemoglobin less than 10 gm/dL were recalled to be given iron therapy and further follow-up. Although we faced problems with both compliance and follow-up, we felt that it was feasible to screen for iron deficiency anemia in the Well Baby Clinic setting. A very high prevalence of anemia was found in the population screened. This justified continuation of the program, intensifying parent education to comply with iron therapy and, more importantly, to teach the proper weaning of their infants to prevent iron deficiency anemia.

Carbamazepine has been used in adults and children for over 30 years. In spite of an excellent therapeutic and side-effect profile in older children, it has never been used as a primary anticonvulsant in neonates. This is the first report of the long-term use of carbamazepine in neonates. Ten full-term neonates with two or more seizures due to hypoxic-ischemic encephalopathy were given 10 mg/kg of carbamazepine as a loading dose via nasogastric tube. Twenty-four hours later, the first five patients began a maintenance regimen of 21 mg/kg/daily, and the remaining five patients began a maintenance regimen of 15 mg/kg/daily, all via nasogastric tube. Therapy was continued for 3 to 9 months. Drug levels were monitored every 2 to 4 hours during the first 24 hours, and on days 2, 4, 8, 15, 30, 45, and 60, and monthly thereafter. Absorption of carbamazepine was excellent even in sick neonates. Therapeutic levels were reached in 2 to 4 hours in all patients. Peak levels were achieved in 4 to 16 hours (mean, 9.2 +/- 4.2). Elimination half-life was 24.5 hours. Levels dropped precipitously around 8 to 15 days and thereafter declined slowly over the next 3 months. Seizure control was excellent; only two patients had one seizure each during the first 10 hours. There were no gastrointestinal, hepatic, hematologic, renal, or dermatologic side effects. This preliminary study shows that carbamazepine may be an effective anticonvulsant for neonatal seizures.

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Objective. To evaluate a simple, relatively inexpensive method using the fluid bed to provide high-intensity double-surface (HIDS) phototherapy and to confirm that the method described is more effective than conventional phototherapy (CPT) in the treatment of neonatal hyperbilirubinemia. Design. Prospective controlled study. Method. HIDS phototherapy (26 to 30 µW/cm2 per nanometer) on the fluid bed (n = 22) versus conventional (7 to 10 µW/cm2 per nanometer) phototherapy (n = 28) was used to treat neonates weighing more than 1500 g with hyperbilirubinemia. Results. After 24 hours of therapy, the bilirubin in the group receiving HIDS phototherapy was significantly lower. The mean rate of fall of bilirubin was 5.34 µmol/L per hour in the group receiving HIDS phototherapy versus 0.7 µmol/L per hour in the group receiving CPT. HIDS phototherapy on a fluid bed was well tolerated. Conclusion. HIDS phototherapy on the fluid bed is significantly more effective in reducing bilirubin than CPT. It can be easily and economically provided using equipment currently available in most neonatal units.