subunit assay), pregnancy-specific a ,-glycoprotein, and cafetoprotein persist longer after some spontaneous abortions than after the birth of normal babies. Pastorfide et al"9 showed that HCG persists for about twice as long after therapeutic abortions as after normal vaginal delivery (22 days as opposed to 11) and attributed this to viable trophoblastic cells being left in the uterus after surgical intervention, since after term delivery there is a more complete removal of placental tissue.Whatever the correct explanation our findings suggest that spontaneous abortions are more relevant to ASB and other abnormalities than has been thought. Because of the short IPG in many of the index cases it might be informative to determine whether the incidence of malformations is reduced when a subsequent pregnancy is delayed after a spontaneous abortion, especially if the HCG concentration is raised. There has been a pronounced fall in the birth rate, particularly in social classes IV and V, which is probably the result of family-planning campaigns. Additional advice could easily be given about procedure after a spontaneous abortion, and if this were done and our hypothesis is correct the incidence of ASB and probably other abnormalities would automatically fall.We thank the obstetricians and paediatricians at Broadgreen, Fazakerly, the Maternity, Mill Road, and Sefton General hospitals, Liverpool, for allowing us to study their case notes, and the clerical staff in the records offices of these hospitals for much help. We are indebted to Professor Frank Harris for valuable advice, and Dr S C Rogers for useful discussions. We are grateful to the F B Baily Charitable Trust and the Nuffield Foundation for financial support.Requests for reprints should be addressed to: Sir Cyril Clarke, Neonate, 1977, 31, 84. 16 Stevenson, A C, and McClarin, R H, Nature, 1957, 180, 198. 17 Clarke, C A, et al, British Medical journal, 1976, 1, 455. 1 Roberts, C J, and Powell, R G, Lancet, 1975, 2, 848. 19 Pastorfide, Greg B, et al, American journal of Obstetrics and Gynecology, 1974, 118, 293. (Accepted 8 February 1978) Creamatocrit: simple clinical technique for estimating fat concentration and energy value of human milk A LUCAS, J A H GIBBS, R L J LYSTER, J D BAUM British Medical Journal, 1978, 1, 1018-1020 Summary and conclusions A simple micromethod has been devised for estimating the fat and energy content of human milk based on the centrifugation of milk in a haematocrit centrifuge. The percentage of cream, or "creamatocrit," is read from the haematocrit capillary tube and is linearly related to the fat and energy content.The technique, which is rapid and cheap, may be used in clinical practice, in research, and in epidemiological studies.

SUMMARY Fourteen newborn babies of different gestational ages (33 to 40 weeks) but similar postnatal age (four to 19 days) were studied during bottle‐feeding using real‐time ultrasonography, combined with respiratory monitoring. Previously undescribed tongue movements and graded changes in the temporal relationships between tongue movements, swallowing and breathing were observed among infants of differing maturity. These were most marked in the least mature infants, but were occasionally seen in term infants. The results suggest that adequate neuromuscular co‐ordination is more a function of gestational maturity than of postnatal sucking experience. The pattern of intraoral events for infants of differing maturity described in this study provides a framework for the study of feeding problems of term and preterm infants. RÉSUMÉ Développement de la coordination, de la succion, de la déglutition et de la respiration chez les nourrissons nés à terme et chez les prématurés Quatorze nouveaux‐nés d'âges differents de gestation (33 à 40 semaines) mais d'âges post‐nataux semblables (quatre à 19 jours) on*** été étudiés durant l'alimentation au biberon en utilisant une échographie en temps reel combinée avec un contrôle respiratoire. Des mouvements de langue non décrits antérieurement et des modifications graduées dans les relations temporelles entre les mouvements de langue, la déglutition et la respiration ont été observés chez les nourrissons de differentes maturités. Ils étaient au plus élevé chez les moins matures des enfants étudiés mais observés occasionnellement chez les nourrissons à terme. Les résultats suggèrent que la coordination neuro‐musculaire adéquate est plus une fonction de la maturité de gestation que de l'expérience post‐natale de succion. La distribution des évènements intra‐oraux pour les nourrissons de differentes maturités décrites dans cette étude fournit une base de travail pour l'étude des problèmes d'alimentation chez les nourrissons à terme et prématurés. ZUSAMMENFASSUNG Koordinationsentwicklung von Saugen, Schlucken und Atmen bei reif‐ und frühgeborenen Kindern Bei 14 Neugeborenen mit verschiedenem Gestationsalter (33 bis 40 Wochen), aber etwa gleichem Lebensalter (vier bis 19 Tage) wurden während der Flaschenfütterung Real‐Zeit Ultraschalluntersuchungen mit gleichzeitigen Aufzeichnungen der Atmung durchgeführt. Es wurden bisher nicht beschriebene Zungenbewegungen und abgestufte Veränderungen in der zeitlichen Relation zwischen Zungenbewegungen, Schlucken und Atmen bei Kindern mit unterschiedlichem Reifegrad festgestellt. Diese waren bei den unreifsten Kindern am ausgeprägtesten, wurden aber auch bei einigen reifen Kindern beobachtet. Die Ergebnisse zeigen, daβ eine richtige neuromuskuläre Koordination eher eine Funktion der Gestationsreife als der postnatalen Saugerfahrung ist. Die Muster intra‐oraler Abläufe bei Kindern unterschiedlicher Reife, die in dieser Studie beschrieben werden, bilden die Basis für Untersuchungen von Fütterungsproblemen bei reif‐ und frühgeborenen Kindern. RESUMEN D...