No abstract

SUMMARYThe postnatal decline of maternally acquired rubella antibody was studied in a large group of infants. A high degree of variability was found in the rate ofantibody decline (half-life). Ninety-two babies had rubella antibody half-lives lying between 14 and 70 days and three had values considerably higher. There was no significant difference between the rubella antibody half-lives of the sexes. The antibody titre at birth was weakly correlated with both birth weight and gestational age. There was a highly significant positive correlation between the baby's antibody titre at birth and that of its mother. There was a positive relationship between the half-life and the persistence of rubella antibody. Some babies had no detectable antibody by 2 months whereas others still possessed antibody at 9 months. It was found that the relationship between the half-life and the rubella antibody titre at or near birth could be described by a rectangular hyperbola.

WHEN a previously well baby dies suddenly and unexpectedly, the cause of death is often obscure. In the past it was usually assumed that death was due to unnatural causes particularly mechanical asphyxia, but as a result of studies made in the last decade,1-7 few continue to hold this opinion. Although it is now generally considered that a specific bacterial cause can be ruled out, there is much to suggest that what has been called sudden unexplained death in infancy may be related to infection possibly from one of a number of different viruses. Thus its peak age and seasonal incidence parallel that of acute respiratory tract infection in infancy; in many instances there is a history of a "cold" in the two to three days that preceded death; moreover, evidence of viral invasion of the respiratory tree is frequently noted at postmortem examination. However, it has been pointed out 3 that when a child dies (in its parents' room, for that matter even in the same bed) it is usually expected that even the most virulent infection producing a fatal degree of toxemia must take some hours at least to develop during which time the child should be expected to become at least miserable and cry. Especially when he is face down there should be some sign of struggle. Why many of these infants are found dead face down and in this posture (rarely observed beyond the fifth month)8 are additional facets of the problem.Severe apneic and cyanotic attacks can fre¬ quently herald the onset of acute symptoms in severe infection in young babies (to be pub¬ lished) and the first signs of extension to the lungs of the "cold" a child has had in the preceding two or three days may be one or a series of severe cyanotic episodes. In effect, suddenly and quite unexpectedly the child stops breathing, goes limp, and becomes blue and there is no assurance that he will recover spon¬ taneously. It is notable that when infants have been observed to die suddenly and unexpectedly, the clinical events reported to accompany the change -1,2,4 have not been inconsistent with the sudden development of a severe apneic episode from which the child failed to recover. The main theme of this paper is that current inter¬ pretation of the circumstances surrounding sudden unexplained death by disregarding the potential effects of severe apneic and cyanotic episodes may have ignored natural behavior that could account for many of the enigmatic features of these deaths, including the face down position.A particular study has been made of infants who suddenly and unexpectedly underwent grave deterioration. The more general aspects of this investigation will be considered in a separate communication. In this report clinical behavior in four babies will be summarized since they illustrated how natural behavior dur¬ ing severe apneic episodes might lead to the quiet adoption of the prone, face down position, where moments before the child lay supine. The epidemiological, clinical, and pathological findings in these cases were consistent with unexplained death of the type ...

SUMMARYThe rates of decline (half-lives) of maternally acquired antibodies of two different specificities in a group of infants were found to be highly variable, ranging from 18 to 192 days for parainfluenza type 3 antibody (54 infants) and from 15 to 251 days for influenza A2 antibody (nine infants). For antibodies of both specificities approximately 75 % of the half-lives were between 15 and 60 days. With parainfluenza type 3 antibody, and possibly with influenza A 2 antibody, the half-lives were inversely proportional to the initial antibody titre of the babies' sera. This relationship could be described by a rectangular hyperbola. Babies with high antibody titres at birth lost this antibody rapidly whereas in babies with low initial titres antibody declined over a longer period.The half-lives of parainfluenza type 3 antibody and influenza A 2 antibody were compared with that of rubella antibody in the same group of infants (previously published). Maternally acquired viral antibodies of different specificities did not necessarily decline at similar rates in any given child. In nine infants, maternally acquired antibodies of two different specificities (rubella and parainfluenza type 3) declined at significantly different rates in the same child. It is suggested that although the half-life of antibody of a given specificity is related to its concentration in the serum, it is independent of the level of serum antibodies of other specificities.

The initial clinical experience with the use of a triple lumen long tube designed for gastrointestinal decompression and enteroclysis is reported in 150 patients. Based on clinical observations, this tube is effective in suctioning retained gastric and intestinal fluid but requires frequent irrigation of the sump port for effective decompression of distended small bowel. In all patients with a preexisting nasogastric tube, the replacement by the decompression/enteroclysis tube was considered more comfortable by the patients. Successful placement of the tube in the jejunum was achieved in 147 of 150 consecutive patients on the initial attempt. The use of this tube obviates dual intubations for decompression and enteroclysis, the attendant discomfort on the patient, and it expedites subsequent performance of enteroclysis if needed. The complications reported with other long intestinal tubes were not observed with this device.