SUMMARY The case notes of 20 infants with hyperkalaemia (defined as two successive serum potassium measurements of >7-5 mmol/l) were reviewed. The incidence of hyperkalaemia was also looked at in an unselected population of 200 low birthweight infants. The mean gestational age of the 20 affected infants was 29 weeks and the mean birth weight 1235 g. The incidence of hyperkalaemia in the cohort of 200 infants weighing less than 1500 g at birth was 3-5%. Hyperkalaemia was associated with a high incidence of cardiac arrhythmia (60%), impaired renal function (50%), and changes on cerebral ultrasonography (88%). Hyperkalaemia responds slowly to conventional treatment with dextrose, insulin, and exchange resins. There is a close temporal relation in some infants between hyperkalaemia and cardiac arrhythmias and periventricular leukomalacia, suggesting a causal association.There are little published data on the incidence and consequences of neonatal hyperkalaemia. It is known to cause cardiac arrythmias, -4 and recent evidence suggests that increased potassium concentrations in cerebrospinal fluid or brain parenchyma may cause spasm of the intracerebral arteries.5 Both these factors could impair the neonatal cerebral circulation.We looked at the incidence of hyperkalaemia in an unselected population of very low birthweight infants (n=200), and reviewed the case notes of 20 infants known to have had hyperkalaemia to estimate the incidence of cardiac arrhythmia, renal impairment, and cerebral abnormality.

SUMMARY Over a period of 20 months six preterm infants have been seen who developed severe acute retinopathy of prematurity (ROP) and who also had ultrasound evidence of extensive cerebral parenchymal changes compatible with severe periventricular leucomalacia. Only one of these infants had a birthweight of less than 1000 g, and their gestational ages ranged from 27 to 30 weeks. The association between these two important complications of preterm birth has led us to postulate that an episode of hypoperfusion of the cerebral circulation sufficient to result in cerebral ischaemia could also reduce an already compromised ocular blood flow and further exacerbate retinal ischaemia, thereby increasing the severity of ROP.Periventricular leucomalacia (PVL), and retinopathy of prematurity (ROP) are both important common complications of preterm birth. Over a two-year period we have noticed the association of severe acute ROP with extensive cerebral intraparenchymal lesions. Both conditions are thought to be ischaemic in nature, and in this article we explore the possibility that the insult responsible for the cerebral ischaemia could also increase the severity of the retinopathy. ResultsOver a period of 20 months 299 infants were examined in the two neonatal units, and six infants were found to have extensive cerebral parenchymal abnormalities together with severe ROP. The records of each of the six infants were examined, and seven indicators of neonatal illness were extracted. These were an Apgar score <5 at 5 minutes, the duration of assisted ventilation, the occurrence of pneumothorax, the presence of a persistent ductus arteriosus (PDA) requiring treatment, proved septicaemia, exchange transfusions, and the number of blood transfusions. Many factors have been reported to be associated with ROP, and include some of those described above.

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sis. The dramatic variation in values of creatine kinase activities in case 2 was unexplained. It was not obviously related to varying degrees of exertion before testing. This phenomenon has been described previously and could lead to diagnostic confusion. The condition is generally regarded as inherited on an autosomal recessive basis, but there is evidence to suggest genetic heterogeneity.These three patients' symptoms, dating from much earlier in childhood, confirm that type V glycogen storage disease may be diagnosed at an earlier age than often reported. In all three symptoms were related to a disinclination to walk up hills. No more specific symptoms than this occurred within the histories. The test for ischaemic lactate concentration is an important and fairly straightforward procedure that should be considered in a child presenting with any of the features detailed in this report. An earlier diagnosis may be particularly important if the recent preliminary report of improvement in symptoms related to a high protein diet is confirmed in other patients.7